Intracranial atherosclerosis related large vessel occlusions (ICAS-O) are challenging to diagnose and manage. The degree of intracranial carotid artery calcification may assist pre-thrombectomy diagnosis of ICAS and guide treatment strategy.
The aim of a study of Tsang et al. from the Division of Neurosurgery, Division of Neurology, Department of Diagnostic Radiology, Queen Mary Hospital, The University of Hong Kong was to determine if intracranial carotid calcification is associated with ICAS-O.
Consecutive large vessel occlusion patients who underwent thrombectomy from 2006 to 2017 were retrospectively studied. Patients were classified into ICAS-O if pre-existing atherosclerotic lesion was identified as the etiology for large vessel occlusion during the thrombectomy. The degree of intracranial carotid artery calcification (ICAC), technical and clinical outcomes of ICAS-O was compared with non-ICAS-O patients.
In a retrospective cohort study of 64 thrombectomy patients, ICAS-O accounted for 14.1% of cases and was associated with higher degree of carotid calcification (mean Woodcock scale 2.8 vs 1.6, p = 0.044), need of stent-retreiver rescue (55.6% vs 5.5%, p = 0.001), and adjuvant stenting or angioplasty (33.3% vs 0%, p = 0.002) compared with non-ICAS-O.
The severity of ICAC may be associated with ICAS-O as the underlying etiology amongst thrombectomy patients. Compared with large vessel occlusion of other causes, ICAS-O was associated with more failure of aspiration and a higher need of adjuvant stenting and angioplasty 1).