Timing Considerations for Endovascular Intervention in Patients with Symptomatic Intracranial Atherosclerotic Stenosis: Insights from a Single-Center Real-World Analysis - Report - MDSpire
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Timing Considerations for Endovascular Intervention in Patients with Symptomatic Intracranial Atherosclerotic Stenosis: Insights from a Single-Center Real-World Analysis
Timing Considerations for Endovascular Intervention in sICAS
Overview
This study evaluates the timing of endovascular treatment for symptomatic intracranial atherosclerotic stenosis (sICAS) and its impact on patient outcomes. It finds that early intervention may not be necessary for certain patients, while delayed intervention is preferable for basilar artery lesions.
Background
Intracranial atherosclerotic stenosis (ICAS) is a significant cause of stroke, particularly in certain populations. The risk of recurrent stroke in symptomatic ICAS patients remains high despite medical management, prompting exploration of endovascular treatments. Understanding the optimal timing for these interventions is crucial for improving patient outcomes.
Data Highlights
Group
30-day Stroke or Death Rate
90-day Unfavorable Outcomes
Early Intervention (≤14 days)
11.3%
18.9%
Delayed Intervention (>14 days)
8.3%
10.7%
Key Findings
30-day stroke or death rates were 11.3% for early intervention and 8.3% for delayed intervention (p = 0.521).
Unfavorable 90-day outcomes were 18.9% in the early group versus 10.7% in the delayed group (p = 0.145).
Independent factors influencing intervention timing included preoperative NIHSS, albumin-to-globulin ratio, and LDL levels.
Thresholds favoring early intervention were NIHSS ≤ 3, albumin-to-globulin ratio < 1.53, and LDL < 2.85 mmol/L.
For posterior circulation lesions, early intervention led to more unfavorable outcomes compared to delayed intervention (29.2% vs. 8.2%, p = 0.033).
Clinical Implications
Clinicians should consider the timing of endovascular interventions in sICAS patients carefully, particularly for those with minor strokes and favorable preoperative scores. Delayed intervention may be more beneficial for patients with basilar artery lesions to reduce the risk of adverse outcomes.
Conclusion
Highlight the need for further studies to validate findings and improve clinical guidelines.
by Yang Yang, Xiaoya Wang, Jialiang Lu, Ye Li, Lili Zhao, Yating Jian, Tao Li, Meijuan Dang, Ziwei Lu, Fangcun Li, Fan Tang, Qingyu Fan, Ning Bu, Huqing Wang, Ru Zhang, An Wen, Guilian Zhang, Hong Fan, Lei Zhang
