Abstract 393: Rescue Intra‐arterial Therapy for Emergent Large Vessel Occlusion Secondary to Intracerebral Atherosclerotic Disease In the Philippines: A Single Center Study
Authors: Geronimo K. , Soliven J. R. , Jocson V. D. , Opeña A. M. 
Published: January 2025

Introduction

Large vessel occlusions (LVO) secondary to intracranial atherosclerotic disease (ICAD) has an estimated prevalence of 10‐30% of all LVO cases, and the usual risk factors associated with it are hypertension, diabetes, ethnicity, and age. To date, the gold standard of treatment for strokes from LVO are intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT). ICAD‐LVO results in increased morbidity and mortality, as well as early re‐occlusion after revascularization therapy. ICAD‐LVO results in re‐occlusion at 30‐50% compared to 5% rate in cardioembolic strokes. Rescue therapy (RT) for re‐stenosis or re‐occlusion includes intra‐arterial (IA) administration of antiplatelets, angioplasty, and emergency stenting. Despite advancements in endovascular therapy and medical management, the optimal approach for rescuing patients who fail initial reperfusion attempts remains a challenging and underexplored area. By documenting RT strategies, we can identify which are effective in such scenarios and ultimately its impact on clinical outcomes. Of note, this is the first study on RT in ICAD‐LVO in the Philippines.

Methods

A retrospective chart review of all emergent LVO who underwent cerebral angiogram for the purpose of endovascular thrombectomy from September 2018 to July 2024 was performed. Those included were patients who underwent rescue therapy for ICAD‐LVO. The following were collected, demographic data (age and sex), admitting MRS, NIHSS score upon admission, underlying co‐morbidities (hypertension, diabetes, history of previous stroke), use of anti‐thrombotics/anti‐coagulants as maintenance medications, ASPECTS or MR ASPECTS, history of IV thrombolysis administration, rescue therapy instituted (IA thrombolytics, stenting, or angioplasty), in‐hospital mortality, and discharge MRS.

Results

Among the 101 LVO patients reviewed, 10 of which were due to ICAD‐LVO and underwent rescue therapy. The mean age was 65 where 80% are male. The demographic data showed that all patients included were hypertensive and half are diabetic and dyslipidemic. 80% (n=8) of patients received IA tirofiban as RT with a mean dose of 960mcg, 1 underwent emergency stenting using a drug eluting coronary stent, and 1 received IA alteplase. No early neurological improvement was seen in those who received RT. For the immediate outcomes, 80% (n=8) of patients had an MRS of 3‐5 upon discharge. Regarding its safety, only 20% (n=2) had hemorrhagic transformation but were asymptomatic. Only 1 patient (10%) with a basilar ICAD‐LVO who received IA tirofiban died, but not as a direct result of the RT, but due to withdrawal of care.

CONCLUSIONS

ICAD‐LVO remains to be a challenging feat to overcome in revascularization therapy and results in worse outcomes. Rescue therapy with IA tirofiban seems to be safe but does not offer added benefit in terms of acute clinical outcomes. A study on long‐term outcomes of patients who received RT for ICAD‐LVO is recommended to better determine its safety and efficacy.