Necessity and timing of angioplasty in acute large-vessel occlusion strokes due to intracranial atherosclerotic disease: A cohort analysis with data from the angel-ACT registry

Front Neurol. 2023 Mar 16:14:1087816. doi: 10.3389/fneur.2023.1087816. eCollection 2023.

Authors

Yiming Deng^{1

2

3}, Yunchu Yao⁴, Xu Tong^{1

2

3}, Yue Yin¹, Anxin Wang^{2

3

5}, Yijun Zhang^{2

3

5}, Baixue Jia^{1

2

3}, Xiaochuan Huo^{1

2

3}, Gang Luo^{1

2

3}, Ning Ma^{1

2

3}, Dapeng Mo^{1

2

3}, Ligang Song^{1

2

3}, Xuan Sun^{1

2

3}, Feng Gao^{1

2

3}, Duanduan Chen^{4

6}

Affiliations

¹ Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
² China National Clinical Research Center for Neurological Diseases, Beijing, China.
³ Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.
⁴ School of Life Science, Beijing Institute of Technology, Beijing, China.
⁵ Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
⁶ School of Medical Technology, Beijing Institute of Technology, Beijing, China.

Abstract

Background: The effects of angioplasty on intracranial atherosclerotic disease (ICAD)-related acute large-vessel occlusion stroke (LVOS) are unknown. We analyzed the efficacy and safety of angioplasty or stenting for ICAD-related LVOS and the optimal treatment duration.

Methods: Patients with ICAD-related LVOS from a prospective cohort of the Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemia Stroke registry were classified as follows: the early intraprocedural angioplasty and/or stenting (EAS) group was defined as the strategy using angioplasty or stenting without mechanical thrombectomy (MT) or one attempt of MT; the non-angioplasty and/or stenting (NAS) group, MT procedure without any angioplasty; and the late intraprocedural angioplasty and/or stenting (LAS) group, using same angioplasty techniques following two or more passes of MT. The primary endpoint was the modified Rankin Scale (mRS) score at 90 days. Other efficacy outcomes included mRS scores 0-1, mRS 0-2, and successful recanalization. Death within 90 days, and symptomatic ICH were safety endpoints. We use propensity score method to diminish the effect of treatment-selection bias. The odds ratio of recanalization rate and mRS score among EAS, NAS, and LAS groups were examined by unadjusted and adjusted logistic regression analysis among unweighted samples and inverse probability of treatment weighting (IPTW) samples.

Results: We divided 475 cases into three groups. Functional outcomes at 90 days were better in the EAS group than in the NAS and LAS groups. The proportion of mRS 0-1, mRS 0-2, and successful recanalization cases were the highest in the EAS group. However, after IPTW, mortality rate among the three groups were similar (EAS vs. NAS vs. LAS: 19.0 vs. 18.1 vs. 18.7%, p = 0.98) as well as symptomatic intracranial hemorrhage within 24 h however, mortality rate and symptomatic intracranial hemorrhage among the three groups were similar. Logistic regression analysis in unweighted samples and IPTW samples both showed that EAS group had better outcomes. IPTW-adjusted logistic regression analysis demonstrated that the EAS group had better outcomes (mRS 0-1) than the NAS group (adjusted odds ratio [aOR], 0.55; 95% confidence interval [CI]: 0.34-0.88, p = 0.01) and LAS (aOR, 0.39; 95% CI: 0.22-0.68, p = 0.001).

Conclusions: Angioplasty and/or stenting should be performed at an early stage for ICAD-related acute LVOS.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03370939.

Keywords: acute large-vessel occlusion strokes; angioplasty; efficacy; intracranial atherosclerotic disease; safety.

Copyright © 2023 Deng, Yao, Tong, Yin, Wang, Zhang, Jia, Huo, Luo, Ma, Mo, Song, Sun, Gao and Chen.

Associated data

ClinicalTrials.gov/NCT03370939

Grants and funding

This work was supported by Beijing Natural Science Foundation (grant number L192010); the National Key Research and Development Program of China (grant number 2018AAA0102601); and the National Natural Science Foundation of China (grant number 82171562).