What question did this study set out to answer?

This study aims to determine the optimal timing for endovascular treatment in patients with symptomatic intracranial atherosclerotic stenosis after acute cerebral infarction.

April 26, 2026Open Access

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

Key Points

This study aims to determine the optimal timing for endovascular treatment in patients with symptomatic intracranial atherosclerotic stenosis after acute cerebral infarction.
Retrospective analysis of consecutive patients undergoing endovascular intervention for sICAS at a single center.
Patients were categorized into early (≤14 days) and delayed (>14 days) intervention groups.
Primary outcomes included stroke or death rates within 30 days and 90-day mRS scores.
Among 174 analyzed patients, the early intervention group had a 30-day stroke or death rate of 11.3% compared to 8.3% in the delayed group (p=0.521).
Unfavorable outcomes at 90 days were 18.9% for early versus 10.7% for delayed intervention (p=0.145).
Posterior circulation lesions showed a significant increase in unfavorable outcomes for early intervention (29.2% vs. 8.2%, p=0.033).

Abstract

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.

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