Endovascular recanalization of the symptomatic non-acute occlusion of large intracranial artery of circulation: preliminary study

Objective To investigate the feasibility, safety and efficacy of endovascular recanalization of the symptomatic occlusion of large intracranial artery in anterior circulation. Methods From October 2015 to December 2017, 13 patients with symptomatic non-acute occlusion of large intracranial artery in anterior circulation were enrolled into this study and underwent endovascular recanalization. The initial procedural results, including the rate of successful recanalization and perioprocedural complications, and angiographic and clinical follow-up results were collected. The functional outcome was evaluated at discharge and 90 days. Results Recanalization was successful in 11 out of 13 patients. Perioperative complications occurred in 8 cases, including distal embolization in 7 cases (3 with symptom and 4 without), in which intracerebral hemorrhage associated with embolectomy was found in 1 case; and distal embolization concomitant with artery dissection in 1 case. At discharge, the symptoms of 10 out of 11 patients with successful recanalization were improved and 1 was unchanged; one of 2 patients with recanalization failure was aggravated and 1 was unchanged. After the procedure, 1 patient with successful recanalization, but complicated with intracerebral hemorrhage associated with embolectomy was lost at follow-up, thus angiographic follow-up was available in the remaining 10 patients. Of the 10 patients, 1 patient developed in-stent restenosis at 12 months and 9 patients had no hemodynamic stenosis/reocclusion. The clinical follow-up was available in 12 patients. No recurrence of TIA or stroke was found in 9 cases with successful recanalization except for 1 case who developed in-stent stenosis and suffered from TIA. At the follow-up of 90 days, 10 patients with successful recanalization showed good function (mRS: 0-2), 2 patients with recanalization failure were deteriorated. Conclusions In strictly selected patients with symptomatic non-acute occlusion of large intracranial artery in anterior circulation, endovascular recanalization was feasible and safe, which may improve patients' symptoms in a short term and reduce the recurrence rate of stroke, but its definite efficacy needs to be confirmed by studies with larger sample and longer follow-up. Key words: Intracranial arterial diseases; Arterial occlusive diseases; Radiology, interventional; Endovascular recanalization, non-acute