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 ten-dency 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 signifi-cantly 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 multi-variate 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.