Endovascular therapy in patients with acute intracranial non-terminal internal carotid artery occlusion (ICA-I)

Christoph Riegler; Regina von Rennenberg; Kerstin Bollweg; Eberhard Siebert; Gian Marco de Marchis; Georg Kägi; Pasquale Mordasini; Mirjam R Heldner; Mauro Magoni; Alessandro Pezzini; Alexander Salerno; Patrik Michel; Christoph Globas; Susanne Wegener; Nicolas Martinez-Majander; Sami Curtze; Maria Luisa Dell'Acqua; Guido Bigliardi; Nabila Wali; Paul J Nederkoorn; Dejana R Jovanovic; Visnja Padjen; Issa Metanis; Ronen R Leker; Giovanni Bianco; Carlo W Cereda; Rosario Pascarella; Marialuisa Zedde; Maria Maddalena Viola; Andrea Zini; João Nuno Ramos; João Pedro Marto; Heinrich J Audebert; Simon Trüssel; Henrik Gensicke; Stefan T Engelter; Christian H Nolte

doi:10.1177/23969873241278948

Endovascular therapy in patients with acute intracranial non-terminal internal carotid artery occlusion (ICA-I)

Eur Stroke J. 2024 Oct 29:23969873241278948. doi: 10.1177/23969873241278948. Online ahead of print.

Authors

Christoph Riegler^{1

2}, Regina von Rennenberg^{1

2}, Kerstin Bollweg^{1

2}, Eberhard Siebert³, Gian Marco de Marchis⁴, Georg Kägi^{4

5}, Pasquale Mordasini⁵, Mirjam R Heldner⁵, Mauro Magoni⁶, Alessandro Pezzini⁷, Alexander Salerno⁸, Patrik Michel⁸, Christoph Globas⁹, Susanne Wegener⁹, Nicolas Martinez-Majander¹⁰, Sami Curtze¹⁰, Maria Luisa Dell'Acqua¹¹, Guido Bigliardi¹¹, Nabila Wali¹², Paul J Nederkoorn¹², Dejana R Jovanovic¹³, Visnja Padjen¹³, Issa Metanis¹⁴, Ronen R Leker¹⁴, Giovanni Bianco¹⁵, Carlo W Cereda¹⁵, Rosario Pascarella¹⁶, Marialuisa Zedde¹⁷, Maria Maddalena Viola¹⁸, Andrea Zini¹⁸, João Nuno Ramos¹⁹, João Pedro Marto²⁰, Heinrich J Audebert^{1

2}, Simon Trüssel^{21

22}, Henrik Gensicke^{21

22}, Stefan T Engelter^{21

22}, Christian H Nolte^{1

2

23

24}

Affiliations

¹ Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.
² Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Bern, Germany.
³ Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Berlin, Germany, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
⁴ Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
⁵ Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
⁶ Department of Neurological Sciences and Vision, ASST Spedali Civili, Brescia, Italy.
⁷ Department of Medicine and Surgery, University of Parma, Stroke Care Program; Department of Emergency, Parma University Hospital, Parma, Italy.
⁸ Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
⁹ Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
¹⁰ Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
¹¹ Stroke Unit, Department of Neuroscience, Ospedale Civile di Baggiovara, Modena University Hospital, Modena, Italy.
¹² Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands.
¹³ Neurology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
¹⁴ Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
¹⁵ Stroke Center and department of Neurology, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland.
¹⁶ Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
¹⁷ Neurology Unit-Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
¹⁸ IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy.
¹⁹ Department of Neuroradiology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
²⁰ Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
²¹ Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland.
²² Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland.
²³ Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.
²⁴ Deutsches Zentrum für Herz-Kreislaufforschung DZHK, Berlin, Germany.

Abstract

Background: Acute intracranial occlusion of the internal carotid artery (ICA) can be distinguished into (a) occlusion of the terminal ICA, involving the proximal segments of the middle or anterior cerebral artery (ICA-L/-T) and (b) non-terminal intracranial occlusions of the ICA with patent circle of Willis (ICA-I). While patients with ICA-L/-T occlusion were included in all randomized controlled trials on endovascular therapy (EVT) in anterior large vessel occlusion, data on EVT in ICA-I occlusion is scarce. We thus aimed to evaluate effectiveness and safety of EVT in ICA-I occlusions in comparison to ICA-L/-T occlusions.

Methods: A large international multicentre cohort was searched for patients with intracranial ICA occlusion treated with EVT between 2014 and 2023. Patients were stratified by ICA occlusion pattern, differentiating ICA-I and ICA-L/-T occlusions. Baseline factors, technical (modified thrombolysis in cerebral infarction (mTICI) scale) and functional outcomes (modified Rankin scale [mRS] at 3 months) as well as rates of (symptomatic) intracranial hemorrhage ([s]ICH) were analyzed.

Results: Of 13,453 patients, 1825 (13.6%) had isolated ICA occlusion. ICA-occlusion pattern was ICA-I in 559 (4.2%) and ICA-L/-T in 1266 (9.4%) patients. Age (years: 74 vs 73), sex (female: 45.8% vs 49.0%) and pre-stroke functional independency (pre-mRS ⩽ 2: 89.9% vs 92.2%) did not differ between the groups. Stroke severity was lower in ICA-I patients (NIHSS at admission: 14 [7-19] vs 17 [13-21] points). EVT was similarly successful with respect to technical (mTICI2b/3: 76.1% (ICA-I) vs 76.6% (ICA-L/-T); aOR 1.01 [0.76-1.35]) and functional outcome (mRS ordinal shift cOR 1.01 [0.83-1.23] in adjusted analyses. Rates of ICH (18.9% vs 34.5%; aOR 0.47 [0.36-0.62] and sICH (4.7% vs 7.3%; aOR 0.58 [0.35-0.97] were lower in ICA-I patients.

Conclusion: EVT might be performed safely and similarly successful in patients with ICA-I occlusions as in patients with ICA-L/-T occlusions.

Keywords: Endovascular therapy; ICA-I Occlusion; ischemic stroke; mechanical thrombectomy.