Should we always retrieve? Endovascular treatment outcomes in emergent large-vessel occlusion due to underlying intracranial atherosclerotic stenosis.

Objective: This study aimed to compare treatment outcomes between patients who received Stent-retriever thrombectomy (SRT) and those who received first stenting without retrieval (FRESH) for treating emergent large vessel occlusion (ELVO) due to underlying intracranial atherosclerotic stenosis (ICAS).

Methods: Consecutive patients with intracranial ELVO who underwent endovascular treatment at Yeungnam University Medical Center between January 2017 and December 2020 were retrospectively selected. ICAS-related ELVO was defined based on a remnant stenosis of > 70 % or a lesser degree of stenosis with a tendency toward reocclusion and/or flow impairment during endovascular treatment. The patients with ICAS-related ELVO were divided into two groups: SRT and FRESH.

Results: 62 consecutive patients with ELVO due to ICAS were enrolled in this study. Among the 62 patients, 32 (51.6 %) underwent SRT, whereas 30 (48.4 %) patients underwent FRESH. There were no significant intergroup differences in the rate of successful reperfusion. However, symptomatic intracranial hemorrhage was significantly more common in the SRT group than in the FRESH group (18.8 % vs. 0 %; odds ratio [OR]: 14.962, 95 % confidence interval [CI]: 0.804-278.311, p = 0.024). Favorable functional outcomes were significantly more frequent in the FRESH group (93.3 % vs. 40.6 %, OR: 20.462, 95 % CI: 4.137-101.21, p < 0.001). The multivariate logistic analysis showed that FRESH (OR: 7.243 [95 % CI: 1.095-47.91]; p = 0.040) was an independent predictor of favorable functional outcomes.

Conclusion: FRESH could be a feasible solution when considering procedural simplicity and focusing on the cause of occlusion.