Angioplasty and/or stenting after thrombectomy in patients with large vessel occlusion associated with underlying intracranial atherosclerotic stenosis: a meta-analysis and systematic review - Scorecard - MDSpire
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Angioplasty and/or stenting after thrombectomy in patients with large vessel occlusion associated with underlying intracranial atherosclerotic stenosis: a meta-analysis and systematic review
Clinical Scorecard: Meta-Analysis and Systematic Review of Angioplasty and Stenting Following Thrombectomy in Patients with Large Vessel Occlusion and Intracranial Atherosclerotic Stenosis
At a Glance
Category
Detail
Condition
Ischemic stroke due to large vessel occlusion (LVO) caused by intracranial atherosclerotic stenosis (ICAS)
Key Mechanisms
Large vessel occlusion from intracranial atherosclerosis leading to ischemic stroke; mechanical thrombectomy with or without angioplasty/stenting to restore vessel patency
Target Population
Patients with LVO stroke secondary to underlying intracranial atherosclerotic stenosis
Care Setting
Acute stroke care settings where mechanical thrombectomy is performed
Key Highlights
Approximately 20% of ischemic strokes are due to large vessel occlusion, with ICAS being a leading cause.
Mechanical thrombectomy is the gold-standard treatment for ICAS-LVO but has high rates of reocclusion and recurrent stroke.
The efficacy and safety of adjunctive angioplasty and/or stenting after thrombectomy remain under investigation with limited clinical trial data.
Guideline-Based Recommendations
Diagnosis
Identify LVO stroke patients with underlying ICAS using imaging and clinical criteria.
Exclude patients with LVO due to non-atherosclerotic causes such as dissection.
Management
Perform mechanical thrombectomy as primary treatment for ICAS-LVO.
Consider adjunctive angioplasty and/or stenting post-thrombectomy to reduce reocclusion risk, pending further evidence.
Monitoring & Follow-up
Assess vessel recanalization success and functional independence at 90 days (mRS scores).
Monitor for early neurological deterioration and intracranial hemorrhage (symptomatic and asymptomatic).
Track mortality outcomes at 90 days post-intervention.
Risks
High risk of vessel reocclusion in ICAS-LVO after thrombectomy alone.
Potential increased risk of intracranial hemorrhage with adjunctive angioplasty/stenting.
Recurrent stroke risk remains elevated in ICAS-LVO patients.
Patient & Prescribing Data
Patients with large vessel occlusion stroke due to intracranial atherosclerotic stenosis undergoing mechanical thrombectomy
Adjunctive angioplasty and/or stenting after thrombectomy may improve vessel recanalization and functional outcomes but requires further validation through randomized controlled trials.
Clinical Best Practices
Use standardized criteria (PICO) to select patients for studies and treatment approaches.
