Optimal timing of endovascular treatment for symptomatic intracranial atherosclerotic stenosis: a real world single center study

Objective – To determine the optimal timing of endovascular treatment for acute cerebral infarction with symptomatic intracranial atherosclerotic stenosis (sICAS) in real world practice. Methods – This retrospective single center study enrolled consecutive sICAS patients undergoing intervention. According to the interval from symptom onset to intervention, patients were divided into early (≤14 days) and delayed (>14 days) intervention groups. Primary outcomes were any stroke or death within 30 days and the 90-day mRS score. Secondary analyses explored factors influencing surgical timing. Results – Among 211 eligible patients, 174 were analyzed, including 53 patients in the early intervention group and 121 patients in the delayed intervention group. The 30-day stroke or death rates were 11.3 and 8.3%, and unfavorable 90-day outcomes were 18.9 and 10.7% in the early and delayed groups (p = 0.521, 0.145). Higher preoperative NIHSS, higher albumin-to-globulin ratio, and higher LDL might be independent factors influencing the doctors’ decision on the timing of the intervention (OR = 0.819, 0.149, 0.394; p = 0.027, 0.042, 0.004). Thresholds favoring early intervention were NIHSS ≤ 3, albumin-to-globulin ratio < 1.53, and LDL < 2.85 mmol/L (AUC = 0.664, 0.603, 0.642; p = 0.001, 0.030, 0.003). For posterior circulation lesions, early intervention might led to more unfavorable outcomes than delayed intervention (29.2% vs. 8.2%, p = 0.033). Conclusion – In anterior circulation sICAS with minor stroke (NIHSS ≤ 3), high Alberta stroke program early CT score (ASPECTS)/posterior circulation ASPECTS (pcASPECTS) (8–9), and well-controlled LDL, intervention timing may not be restricted, whereas Basilar artery (BA) lesions appear better suited for delayed intervention. Multiple parallel severe stenoses, severe pre-existing global brain injury, and plaque high-signal intensity did not influence on the surgical timing. The conclusions of this study should be validated in future prospective studies.