ISC 2026 | Identifying ICAD-related LVO using clinical background, laboratory findings, and imaging findings

There are three main pillars to identify ICAD-related LVO. The first pillar is clinical background. Compared to embolic LVO patients, ICAD patients tend to be younger and mainly male. They frequently have risk factors like smoking, hypertension, dyslipidemia, or diabetes. And a critical factor is atrial fibrillation absence. If you see the LVO patient without atrial fibrillation, you should suspect ICAD etiology. And the second pillar is laboratory findings. ICAD patients show higher total cholesterol levels, higher LDL levels, and lower brain natriuretic peptide levels. Because brain natriuretic peptide, or BNP, is a strong indicator for atrial fibrillation. So its cut-off value less than 100 ng per ml is very useful for differentiation. And the third pillar is imaging findings. There are two key signs to predict ICAD-related LVO. One is a truncal-type occlusion. It’s an occlusion located at the trunk of the occluded artery. And the other is non-culprit stenosis, or NOCS. NOCS is defined as greater than 50% stenosis in vessels other than the culprit artery. This is a simple message that if you see vessel stenosis in an LVO patient, you should suspect ICAD etiology. With these three pillars, we can predict ICAD-LVO precisely. And my advice for procedure is preparation. As ICAD-LVO is associated with a substantially higher rate of reocclusion, we should be ready to rescue therapy such as viral angioplasty or intracranial stenting.

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