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Diel NJ, Gerner ST, Alhaj Omar O, Kalder J, Manz E, Keschenau PR, Struffert T, Brueckner T, Huttner HB, Doeppner TR. Rendezvous intervention using combined surgical carotid endarterectomy followed by endovascular thrombectomy in patients with acute tandem occlusions: a proof-of-concept experience at a tertiary care center. Neurol Res Pract 2023; 5:60. [PMID: 38057910 DOI: 10.1186/s42466-023-00290-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/13/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Endovascular thrombectomy (EVT) is highly effective in acute stroke patients with intracranial large vessel occlusion (LVO), however, presence of concomitant cervical occlusion of the internal carotid artery (ICA) may limit the endovascular access. This study describes feasibility and efficacy of a surgical carotid access (cutdown) to perform interdisciplinary recanalization therapy including carotid endarterectomy (CEA) followed by EVT for recanalization of intracranial LVO in stroke patients with tandem occlusions. METHODS We identified stroke patients with tandem occlusions who underwent a combined surgical-endovascular approach over a 5-year period. Surgical cutdown was provided by a cardiovascular surgery team at the angio-suite followed by EVT performed by the neuroradiological team. Demographics, stroke characteristics, treatments including antithrombotic management, procedure times, and clinical follow-up were assessed. RESULTS Four patients with acute stroke because of tandem occlusions received CEA followed by EVT (two patients after frustrating femoral catheterization, two as first-line approach). Successful recanalization (TICI ≥ 2b) via endovascular thrombectomy was achieved in all patients at a median of 28 min after successful surgical CEA. Intraprocedural complication was observed in one case (25%; i.e. ICA dissection). CONCLUSIONS This small study provides evidence that a combined interdisciplinary approach of CEA followed by EVT in the angio-suite in acute stroke patients with tandem occlusions is a feasible procedure in patients otherwise not accessible to endovascular recanalizing therapy and, therefore, high likelihood of developing large hemispheric infarction. Prospective data are warranted to identify patients who benefit from this combined approach as first-line therapy.
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Affiliation(s)
- Norma J Diel
- Department of Neurology, University Hospital Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - Stefan T Gerner
- Department of Neurology, University Hospital Giessen, Klinikstrasse 33, 35392, Giessen, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg, Marburg, Germany
| | - Omar Alhaj Omar
- Department of Neurology, University Hospital Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - Johannes Kalder
- Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
| | - Enikö Manz
- Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
| | - Paula R Keschenau
- Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
| | - Tobias Struffert
- Department of Neuroradiology, University Hospital Giessen, Giessen, Germany
| | - Thomas Brueckner
- Department of Neuroradiology, University Hospital Giessen, Giessen, Germany
| | - Hagen B Huttner
- Department of Neurology, University Hospital Giessen, Klinikstrasse 33, 35392, Giessen, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg, Marburg, Germany
| | - Thorsten R Doeppner
- Department of Neurology, University Hospital Giessen, Klinikstrasse 33, 35392, Giessen, Germany.
- Center for Mind, Brain and Behavior (CMBB), University of Marburg, Marburg, Germany.
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