1
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Galecio-Castillo M, Guerrero WR, Hassan AE, Farooqui M, Jumaa MA, Divani AA, Abraham MG, Petersen NH, Fifi JT, Malik AM, Siegler JE, Nguyen TN, Sheth SA, Yoo AJ, Linares G, Janjua N, Quispe-Orozco D, Olivé-Gadea M, Tekle WG, Zaidi SF, Sabbagh SY, Barkley T, Prasad A, De Leacy RA, Abdalkader M, Salazar-Marioni S, Soomro J, Gordon W, Turabova C, Rodriguez-Calienes A, Dibas M, Mokin M, Yavagal DR, Ribo M, Jovin TG, Ortega-Gutierrez S. Cervical Dissection in Patients With Tandem Lesions Is Associated With Distal Embolism and Lower Recanalization Success. Stroke 2024; 55:1808-1817. [PMID: 38913799 DOI: 10.1161/strokeaha.123.046148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 05/13/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Tandem lesions consist of cervical internal carotid artery (ICA) stenosis or occlusion, most commonly of atherosclerosis or dissection etiology, plus a large vessel occlusion. In this study, we compare outcomes in patients with atherosclerosis versus dissection of the cervical ICA. METHODS This multicenter retrospective cohort study includes data from tandem lesion patients who underwent endovascular treatment from 2015 to 2020. Atherosclerosis was defined as ICA stenosis/occlusion associated with a calcified lesion and dissection by the presence of a tapered or flame-shaped lesion and intramural hematoma. Primary outcome: 90-day functional independence (modified Rankin Scale score, 0-2); secondary outcomes: 90-day favorable shift in the modified Rankin Scale score, modified Thrombolysis in Cerebral Infarction score 2b-3, modified Thrombolysis in Cerebral Infarction score 2c-3, symptomatic intracranial hemorrhage, parenchymal hematoma type 2, petechial hemorrhage, distal embolization, early neurological improvement, and mortality. Analysis was performed with matching by inverse probability of treatment weighting. RESULTS We included 526 patients (68 [59-76] years; 31% females); 11.2% presented dissection and 88.8%, atherosclerosis. Patients with dissection were younger, had lower rates of hypertension, hyperlipidemia, diabetes, and smoking history. They also exhibited higher rates of ICA occlusion, multiple stents (>1), and lower rates of carotid self-expanding stents. After matching and adjusting for covariates, there were no differences in 90-day functional independence. The rate of successful recanalization was significantly lower in the dissection group (adjusted odds ratio, 0.38 [95% CI, 0.16-0.91]; P=0.031), which also had significantly higher rates of distal emboli (adjusted odds ratio, 2.53 [95% CI, 1.15-5.55]; P=0.021). There were no differences in other outcomes. Acute ICA stenting seemed to increase the effect of atherosclerosis in successful recanalization. CONCLUSIONS This study reveals that among patients with acute stroke with tandem lesions, cervical ICA dissection is associated with higher rates of distal embolism and lower rates of successful recanalization than atherosclerotic lesions. Using techniques to minimize the risk of distal embolism may mitigate this contrast. Further prospective randomized trials are warranted to fully understand these associations.
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Affiliation(s)
- Milagros Galecio-Castillo
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City (M.G.-C., M.F., D.Q.-O., A.R.-C., M.D., S.O.-G.)
| | - Waldo R Guerrero
- Department of Neurology and Brain Repair, University of South Florida, Tampa (W.R.G., M.M.)
| | - Ameer E Hassan
- Department of Neurology, Valley Baptist Medical Center/University of Texas Rio Grande Valley, Harlingen (A.E.H., W.G.T.)
| | - Mudassir Farooqui
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City (M.G.-C., M.F., D.Q.-O., A.R.-C., M.D., S.O.-G.)
| | - Mouhammad A Jumaa
- Department of Neurology, ProMedica Toledo Hospital, OH (M.A.J., S.F.Z.)
| | - Afshin A Divani
- Department of Neurology, University of New Mexico Health Science Center, Albuquerque (A.A.D., S.Y.S.)
| | - Michael G Abraham
- Department of Neurology, University of Kansas Medical Center (M. Abraham, T.B.)
| | - Nils H Petersen
- Department of Neurology, Yale University School of Medicine, New Haven, CT (N.H.P., A.P.)
| | - Johanna T Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.F., R.D.L.)
| | - Amer M Malik
- Department of Neurology, University of Miami Miller School of Medicine, FL (A.M.M., D.R.Y.)
| | - James E Siegler
- Cooper Neurological Institute, Cooper University Hospital, Camden, NJ (J.E.S., T.G.J.)
- Cooper Medical School of Rowan University, Candem, NJ (J.E.S., T.G.J.)
| | - Thanh N Nguyen
- Department of Neurology, Boston Medical Center, MA (T.N.N., M. Abdalkader)
| | - Sunil A Sheth
- Department of Neurology, UT Health McGovern Medical School, Houston, TX (S.S., S.S.-M.)
| | - Albert J Yoo
- Texas Stroke Institute, Dallas-Fort Worth (A.J.Y., J.S.)
| | - Guillermo Linares
- Department of Neurology, Saint Louis University, St. Louis, MO (G.L., W.G.)
| | - Nazli Janjua
- Asia Pacific Comprehensive Stroke Institute, Pomona Valley Hospital Medical Center, CA (N.J., C.T.)
| | - Darko Quispe-Orozco
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City (M.G.-C., M.F., D.Q.-O., A.R.-C., M.D., S.O.-G.)
| | - Marta Olivé-Gadea
- Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain (M.O.-G., M.R.)
| | - Wondwossen G Tekle
- Department of Neurology, Valley Baptist Medical Center/University of Texas Rio Grande Valley, Harlingen (A.E.H., W.G.T.)
| | - Syed F Zaidi
- Department of Neurology, ProMedica Toledo Hospital, OH (M.A.J., S.F.Z.)
| | - Sara Y Sabbagh
- Department of Neurology, University of New Mexico Health Science Center, Albuquerque (A.A.D., S.Y.S.)
| | - Tiffany Barkley
- Department of Neurology, University of Kansas Medical Center (M. Abraham, T.B.)
| | - Ayush Prasad
- Department of Neurology, Yale University School of Medicine, New Haven, CT (N.H.P., A.P.)
| | - Reade A De Leacy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.F., R.D.L.)
| | - Mohamad Abdalkader
- Department of Neurology, Boston Medical Center, MA (T.N.N., M. Abdalkader)
| | | | - Jazba Soomro
- Texas Stroke Institute, Dallas-Fort Worth (A.J.Y., J.S.)
| | - Weston Gordon
- Department of Neurology, Saint Louis University, St. Louis, MO (G.L., W.G.)
| | - Charoskhon Turabova
- Asia Pacific Comprehensive Stroke Institute, Pomona Valley Hospital Medical Center, CA (N.J., C.T.)
| | - Aaron Rodriguez-Calienes
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City (M.G.-C., M.F., D.Q.-O., A.R.-C., M.D., S.O.-G.)
- Neuroscience, Clinical Effectiveness and Public Health Research Group, Universidad Científica del Sur, Lima, Peru (A.R.-C.)
| | - Mahmoud Dibas
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City (M.G.-C., M.F., D.Q.-O., A.R.-C., M.D., S.O.-G.)
| | - Maxim Mokin
- Department of Neurology and Brain Repair, University of South Florida, Tampa (W.R.G., M.M.)
| | - Dileep R Yavagal
- Department of Neurology, University of Miami Miller School of Medicine, FL (A.M.M., D.R.Y.)
| | - Marc Ribo
- Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain (M.O.-G., M.R.)
| | - Tudor G Jovin
- Cooper Neurological Institute, Cooper University Hospital, Camden, NJ (J.E.S., T.G.J.)
- Cooper Medical School of Rowan University, Candem, NJ (J.E.S., T.G.J.)
| | - Santiago Ortega-Gutierrez
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City (M.G.-C., M.F., D.Q.-O., A.R.-C., M.D., S.O.-G.)
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2
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Farooqui M, Zaidat OO, Hassan AE, Quispe-Orozco D, Petersen N, Divani AA, Ribo M, Abraham M, Fifi J, Guerrero WR, Malik AM, Siegler JE, Nguyen TN, Sheth S, Yoo AJ, Linares G, Janjua N, Galecio-Castillo M, Tekle WG, Ringheanu VM, Oliver M, Dawod G, Kobsa J, Prasad A, Ikram A, Lin E, Below K, Zevallos CB, Gadea MO, Qureshi A, Dajles A, Matsoukas S, Rana A, Abdalkader M, Salazar-Marioni S, Soomro J, Gordon W, Vivanco-Suarez J, Turabova C, Mokin M, Yavagal DR, Jumaa MA, Ortega-Gutierrez S. Functional and Safety Outcomes of Carotid Artery Stenting and Mechanical Thrombectomy for Large Vessel Occlusion Ischemic Stroke With Tandem Lesions. JAMA Netw Open 2023; 6:e230736. [PMID: 36857054 PMCID: PMC9978940 DOI: 10.1001/jamanetworkopen.2023.0736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/06/2023] [Indexed: 03/02/2023] Open
Abstract
Importance Approximately 10% to 20% of large vessel occlusion (LVO) strokes involve tandem lesions (TLs), defined as concomitant intracranial LVO and stenosis or occlusion of the cervical internal carotid artery. Mechanical thrombectomy (MT) may benefit patients with TLs; however, optimal management and procedural strategy of the cervical lesion remain unclear. Objective To evaluate the association of carotid artery stenting (CAS) vs no stenting and medical management with functional and safety outcomes among patients with TL-LVOs. Design, Setting, and Participants This cross-sectional study included consecutive patients with acute anterior circulation TLs admitted across 17 stroke centers in the US and Spain between January 1, 2015, and December 31, 2020. Data analysis was performed from August 2021 to February 2022. Inclusion criteria were age of 18 years or older, endovascular therapy for intracranial occlusion, and presence of extracranial internal carotid artery stenosis (>50%) demonstrated on pre-MT computed tomography angiography, magnetic resonance angiography, or digital subtraction angiography. Exposures Patients with TLs were divided into CAS vs nonstenting groups. Main Outcomes and Measures Primary clinical and safety outcomes were 90-day functional independence measured by a modified Rankin Scale (mRS) score of 0 to 2 and symptomatic intracranial hemorrhage (sICH), respectively. Secondary outcomes were successful reperfusion (modified Thrombolysis in Cerebral Infarction score ≥2b), discharge mRS score, ordinal mRS score, and mortality at 90 days. Results Of 685 patients, 623 (mean [SD] age, 67 [12.2] years; 406 [65.2%] male) were included in the analysis, of whom 363 (58.4%) were in the CAS group and 260 (41.6%) were in the nonstenting group. The CAS group had a lower proportion of patients with atrial fibrillation (38 [10.6%] vs 49 [19.2%], P = .002), a higher proportion of preprocedural degree of cervical stenosis on digital subtraction angiography (90%-99%: 107 [32.2%] vs 42 [20.5%], P < .001) and atherosclerotic disease (296 [82.0%] vs 194 [74.6%], P = .003), a lower median (IQR) National Institutes of Health Stroke Scale score (15 [10-19] vs 17 [13-21], P < .001), and similar rates of intravenous thrombolysis and stroke time metrics when compared with the nonstenting group. After adjustment for confounders, the odds of favorable functional outcome (adjusted odds ratio [aOR], 1.67; 95% CI, 1.20-2.40; P = .007), favorable shift in mRS scores (aOR, 1.46; 95% CI, 1.02-2.10; P = .04), and successful reperfusion (aOR, 1.70; 95% CI, 1.02-3.60; P = .002) were significantly higher for the CAS group compared with the nonstenting group. Both groups had similar odds of sICH (aOR, 0.90; 95% CI, 0.46-2.40; P = .87) and 90-day mortality (aOR, 0.78; 95% CI, 0.50-1.20; P = .27). No heterogeneity was noted for 90-day functional outcome and sICH in prespecified subgroups. Conclusions and Relevance In this multicenter, international cross-sectional study, CAS of the cervical lesion during MT was associated with improvement in functional outcomes and reperfusion rates without an increased risk of sICH and mortality in patients with TLs.
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Affiliation(s)
- Mudassir Farooqui
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City
| | - Osama O. Zaidat
- Department of Neurology, Saint Vincent Mercy Hospital, Toledo, Ohio
| | - Ameer E. Hassan
- Department of Neurology, Valley Baptist Medical Center/University of Texas Rio Grande Valley, Harlingen
| | - Darko Quispe-Orozco
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City
| | - Nils Petersen
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Afshin A. Divani
- Department of Neurology, University of New Mexico Health Science Center, Albuquerque
| | - Marc Ribo
- Department of Neurology, Hospital Vall d’Hebron, Barcelona, Barcelona, Spain
| | - Michael Abraham
- Department of Neurology, University of Kansas Medical Center, Kansas City
| | - Johanna Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Waldo R. Guerrero
- Department of Neurology and Brain Repair, University of South Florida, Tampa
| | - Amer M. Malik
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida
| | - James E. Siegler
- Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey
| | - Thanh N. Nguyen
- Department of Neurology, Boston Medical Center, Boston, Massachusetts
| | - Sunil Sheth
- Department of Neurology, UTHealth McGovern Medical School, Houston, Texas
| | | | - Guillermo Linares
- Department of Neurology, Saint Louis University School of Medicine, St Louis, Missouri
| | - Nazli Janjua
- Asia Pacific Comprehensive Stroke Institute, Pomona Valley Hospital Medical Center, Pomona, California
| | | | - Wondewossen G. Tekle
- Department of Neurology, Valley Baptist Medical Center/University of Texas Rio Grande Valley, Harlingen
| | - Victor M. Ringheanu
- Department of Clinical Research, Valley Baptist Medical Center, Harlingen, Texas
| | - Marion Oliver
- Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Giana Dawod
- Department of Neurology, Weill Cornell Medicine, New York, New York
| | - Jessica Kobsa
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Ayush Prasad
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Asad Ikram
- Department of Neurology, University of New Mexico Health Science Center, Albuquerque
| | - Eugene Lin
- Department of Neurology, Saint Vincent Mercy Hospital, Toledo, Ohio
| | - Kristine Below
- Department of Neurology, Saint Vincent Mercy Hospital, Toledo, Ohio
| | - Cynthia B. Zevallos
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City
| | - Marta Olivé Gadea
- Department of Neurology, Hospital Vall d’Hebron, Barcelona, Barcelona, Spain
| | - Abid Qureshi
- Department of Neurology, University of Kansas Medical Center, Kansas City
| | - Andres Dajles
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City
| | - Stavros Matsoukas
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ameena Rana
- Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey
| | | | | | | | - Weston Gordon
- Department of Neurology, Saint Louis University School of Medicine, St Louis, Missouri
| | - Juan Vivanco-Suarez
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City
| | - Charoskhon Turabova
- Asia Pacific Comprehensive Stroke Institute, Pomona Valley Hospital Medical Center, Pomona, California
| | - Maxim Mokin
- Department of Neurology and Brain Repair, University of South Florida, Tampa
| | - Dileep R. Yavagal
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida
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3
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Da Ros V, Pusceddu F, Lattanzi S, Scaggiante J, Sallustio F, Marrama F, Bandettini di Poggio M, Toscano G, Di Giuliano F, Rolla-Bigliani C, Ruggiero M, Haznedari N, Sgreccia A, Sanfilippo G, Finocchi C, Diomedi M, Tomasi SO, Palmisciano P, Umana GE, Strigari L, Griessenauer CJ, Pitocchi F, Garaci F, Floris R. Endovascular treatment of patients with acute ischemic stroke and tandem occlusion due to internal carotid artery dissection: A multicenter experience. Neuroradiol J 2023. [PMID: 35699167 DOI: 10.1177/19714009221089026]] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND The optimal management of patients with acute ischemic stroke (AIS) due to tandem occlusion (TO) and underlying carotid dissection (CD) remains unclear. OBJECTIVE We present our multicenter-experience of endovascular treatment (EVT) approach used and outcomes for AIS patients with CD-related TO (CD-TO). METHODS Consecutive AIS patients underwent EVT for CD-TO at five Italian Neuro-interventional Tertiary Stroke Centers were retrospectively identified. TO from atherosclerosis and other causes of, were excluded from the final analysis. Primary outcome was successful (mTICI 2b-3) and complete reperfusion (mTICI 3); secondary outcome was patients' 3-months functional independence (mRS≤2). RESULTS Among 214 AIS patients with TO, 45 presented CD-TO. Median age was 54 years (range 29-86), 82.2% were male. Age <65 years (p < 0.0001), lower baseline NIHSS score (p = 0.0002), and complete circle of Willis (p = 0.0422) were associated with mRS ≤ 2 at the multivariate analysis. Comparisons between antegrade and retrograde approaches resulted in differences for baseline NIHSS scores (p = 0.001) and number of EVT attempts per-procedure (p = 0.001). No differences in terms of recanalization rates were observed between antegrade and retrograde EVT approaches (p = 0.811) but higher rates of mTICI3 revascularization was observed with the retrograde compared to the antegrade approach (78.6% vs 73.3%), anyway not statistically significant. CD management technique (angioplasty vs aspiration vs emergent stenting) did not correlate with 3-months mRS≤2. CONCLUSION AIS patients with CD-TO were mostly treated with the retrograde approach with lower number of attempts per-procedure but it offered similar recanalization rates compared with the antegrade approach. Emergent carotid artery stenting (CAS) proved to be safe for CD management but it does not influence 3-months patients' clinical outcomes.
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Affiliation(s)
- Valerio Da Ros
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, 9318University of Rome Tor Vergata, Italy
| | - Federica Pusceddu
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, 9318University of Rome Tor Vergata, Italy
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Italy
| | - Jacopo Scaggiante
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA
| | | | - Federico Marrama
- Comprehensive Stroke Center, 9318University of Rome Tor Vergata, Italy
| | | | - Gianpaolo Toscano
- Stroke Unit University Policlinico San Matteo, IRCCS Mondino Fundation, Italy
| | - Francesca Di Giuliano
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, 9318University of Rome Tor Vergata, Italy
| | - Claudia Rolla-Bigliani
- Department of Diagnostic and Interventional Neuroradiology, University Hospital, San Martino, Italy
| | | | | | - Alessandro Sgreccia
- Clinic of Neuroradiology and Interventional Neuroradiology, 18494AOU Ospedali Riuniti di Ancona, Italy
| | - Giuseppina Sanfilippo
- Department of Diagnostic and Interventional Radiology and Neuroradiology, IRCCS Policlinico San Matteo, Italy
| | - Cinzia Finocchi
- Department of Neurosciences, Policlinico Hospital San Martino, University of Genova, Italy
| | - Marina Diomedi
- Department of Systemic Medicine, 9318University of Rome Tor Vergata, Italy
| | - Santino O Tomasi
- Department of Neurological Surgery, Christian Doppler Klinik, 31507Paracelsus Medical University, Salzburg, Austria.,Laboratory for Microsurgical Neuroanatomy, Christian Doppler Klinik, 31507Paracelsus Medical University, Salzburg, Austria
| | - Paolo Palmisciano
- Department of Neurosurgery, Trauma and Gamma-Knife Center, 18531Cannizzaro Hospital, Italy
| | - Giuseppe E Umana
- Department of Neurosurgery, Trauma and Gamma-Knife Center, 18531Cannizzaro Hospital, Italy
| | - Lidia Strigari
- Department of Medical Physics, 18494IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Christoph J Griessenauer
- Department of Neurological Surgery, Christian Doppler Klinik, 31507Paracelsus Medical University, Salzburg, Austria.,Department of Neurosurgery, Geisinger Health System, Danville, PA, USA.,Research Institute of Neurointervention, 31507Paracelsus Medical University, Salzburg, Austria
| | - Francesca Pitocchi
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, 9318University of Rome Tor Vergata, Italy
| | - Francesco Garaci
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, 9318University of Rome Tor Vergata, Italy
| | - Roberto Floris
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, 9318University of Rome Tor Vergata, Italy
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4
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Da Ros V, Pusceddu F, Lattanzi S, Scaggiante J, Sallustio F, Marrama F, Bandettini di Poggio M, Toscano G, Di Giuliano F, Rolla-Bigliani C, Ruggiero M, Haznedari N, Sgreccia A, Sanfilippo G, Finocchi C, Diomedi M, Tomasi SO, Palmisciano P, Umana GE, Strigari L, Griessenauer CJ, Pitocchi F, Garaci F, Floris R. Endovascular treatment of patients with acute ischemic stroke and tandem occlusion due to internal carotid artery dissection: A multicenter experience. Neuroradiol J 2023; 36:86-93. [PMID: 35699167 PMCID: PMC9893158 DOI: 10.1177/19714009221108673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The optimal management of patients with acute ischemic stroke (AIS) due to tandem occlusion (TO) and underlying carotid dissection (CD) remains unclear. OBJECTIVE We present our multicenter-experience of endovascular treatment (EVT) approach used and outcomes for AIS patients with CD-related TO (CD-TO). METHODS Consecutive AIS patients underwent EVT for CD-TO at five Italian Neuro-interventional Tertiary Stroke Centers were retrospectively identified. TO from atherosclerosis and other causes of, were excluded from the final analysis. Primary outcome was successful (mTICI 2b-3) and complete reperfusion (mTICI 3); secondary outcome was patients' 3-months functional independence (mRS≤2). RESULTS Among 214 AIS patients with TO, 45 presented CD-TO. Median age was 54 years (range 29-86), 82.2% were male. Age <65 years (p < 0.0001), lower baseline NIHSS score (p = 0.0002), and complete circle of Willis (p = 0.0422) were associated with mRS ≤ 2 at the multivariate analysis. Comparisons between antegrade and retrograde approaches resulted in differences for baseline NIHSS scores (p = 0.001) and number of EVT attempts per-procedure (p = 0.001). No differences in terms of recanalization rates were observed between antegrade and retrograde EVT approaches (p = 0.811) but higher rates of mTICI3 revascularization was observed with the retrograde compared to the antegrade approach (78.6% vs 73.3%), anyway not statistically significant. CD management technique (angioplasty vs aspiration vs emergent stenting) did not correlate with 3-months mRS≤2. CONCLUSION AIS patients with CD-TO were mostly treated with the retrograde approach with lower number of attempts per-procedure but it offered similar recanalization rates compared with the antegrade approach. Emergent carotid artery stenting (CAS) proved to be safe for CD management but it does not influence 3-months patients' clinical outcomes.
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Affiliation(s)
- Valerio Da Ros
- Diagnostic Imaging Unit, Department
of Biomedicine and Prevention, University of Rome Tor
Vergata, Italy
| | - Federica Pusceddu
- Diagnostic Imaging Unit, Department
of Biomedicine and Prevention, University of Rome Tor
Vergata, Italy
| | - Simona Lattanzi
- Neurological Clinic, Department of
Experimental and Clinical Medicine, Marche Polytechnic
University, Italy
| | - Jacopo Scaggiante
- Department of Radiology and
Radiological Science, Medical University of South
Carolina, Charleston, USA
| | | | - Federico Marrama
- Comprehensive Stroke Center, University of Rome Tor
Vergata, Italy
| | | | - Gianpaolo Toscano
- Stroke Unit University Policlinico
San Matteo, IRCCS Mondino Fundation, Italy
| | - Francesca Di Giuliano
- Diagnostic Imaging Unit, Department
of Biomedicine and Prevention, University of Rome Tor
Vergata, Italy
| | - Claudia Rolla-Bigliani
- Department of Diagnostic and
Interventional Neuroradiology, University Hospital, San Martino, Italy
| | | | | | - Alessandro Sgreccia
- Clinic of Neuroradiology and
Interventional Neuroradiology, AOU Ospedali Riuniti di
Ancona, Italy
| | - Giuseppina Sanfilippo
- Department of Diagnostic and
Interventional Radiology and Neuroradiology, IRCCS Policlinico San
Matteo, Italy
| | - Cinzia Finocchi
- Department of Neurosciences,
Policlinico Hospital San Martino, University of Genova, Italy
| | - Marina Diomedi
- Department of Systemic Medicine, University of Rome Tor
Vergata, Italy
| | - Santino O Tomasi
- Department of Neurological
Surgery, Christian Doppler Klinik, Paracelsus Medical
University, Salzburg, Austria
- Laboratory for Microsurgical
Neuroanatomy, Christian Doppler Klinik, Paracelsus Medical
University, Salzburg, Austria
| | - Paolo Palmisciano
- Department of Neurosurgery,
Trauma and Gamma-Knife Center, Cannizzaro Hospital, Italy
| | - Giuseppe E Umana
- Department of Neurosurgery,
Trauma and Gamma-Knife Center, Cannizzaro Hospital, Italy
| | - Lidia Strigari
- Department of Medical Physics, IRCCS Azienda
Ospedaliero-Universitaria di Bologna, Italy
| | - Christoph J Griessenauer
- Department of Neurological
Surgery, Christian Doppler Klinik, Paracelsus Medical
University, Salzburg, Austria
- Department of Neurosurgery, Geisinger Health System, Danville, PA, USA
- Research Institute of
Neurointervention, Paracelsus Medical
University, Salzburg, Austria
| | - Francesca Pitocchi
- Diagnostic Imaging Unit, Department
of Biomedicine and Prevention, University of Rome Tor
Vergata, Italy
| | - Francesco Garaci
- Diagnostic Imaging Unit, Department
of Biomedicine and Prevention, University of Rome Tor
Vergata, Italy
| | - Roberto Floris
- Diagnostic Imaging Unit, Department
of Biomedicine and Prevention, University of Rome Tor
Vergata, Italy
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5
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van der Steen W, van der Ende NA, van Kranendonk KR, Chalos V, van Oostenbrugge RJ, van Zwam WH, Roos YB, van Doormaal PJ, van Es AC, Lingsma HF, Majoie CB, van der Lugt A, Dippel DW, Roozenbeek B, Boiten J, Albert Vos J, Jansen IG, Mulder MJ, Goldhoorn RJB, Compagne KC, Kappelhof M, Brouwer J, den Hartog SJ, Emmer BJ, Coutinho JM, Schonewille WJ, Albert Vos J, Wermer MJ, van Walderveen MA, Staals J, Hofmeijer J, Martens JM, Lycklama à Nijeholt GJ, Boiten J, de Bruijn SF, van Dijk LC, van der Worp HB, Lo RH, van Dijk EJ, Boogaarts HD, de Vries J, de Kort PL, van Tuijl J, Peluso JP, Fransen P, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Uyttenboogaart M, Eschgi O, Bokkers RP, Schreuder TH, Heijboer RJ, Keizer K, Yo LS, den Hertog HM, Bulut T, Brouwers PJ, Lycklama GJ, van Walderveen MA, Sprengers ME, Jenniskens SF, van den Berg R, Yoo AJ, Beenen LF, Postma AA, Roosendaal SD, van der Kallen BF, van den Wijngaard IR, Emmer BJ, Martens JM, Yo LS, Vos JA, Bot J, Meijer A, Ghariq E, Bokkers RP, van Proosdij MP, Krietemeijer GM, Peluso JP, Boogaarts HD, Lo R, Dinkelaar W, Auke P, Hammer B, Pegge S, van der Hoorn A, Vinke S, Lycklama à Nijeholt GJ, Boiten J, Vos JA, Hofmeijer J, Martens JM, van der Worp HB, Hofmeijer J, Flach HZ, el Ghannouti N, Sterrenberg M, Pellikaan W, Sprengers R, Elfrink M, Simons M, Vossers M, de Meris J, Vermeulen T, Geerlings A, van Vemde G, Simons T, Messchendorp G, Nicolaij N, Bongenaar H, Bodde K, Kleijn S, Lodico J, Droste H, Wollaert M, Verheesen S, Jeurrissen D, Bos E, Drabbe Y, Sandiman M, Aaldering N, Zweedijk B, Vervoort J, Ponjee E, Romviel S, Kanselaar K, Barning D, Venema E, Geuskens RR, van Straaten T, Ergezen S, Harmsma RR, Muijres D, de Jong A, Berkhemer OA, Boers AM, Huguet J, Groot P, Mens MA, Treurniet KM, Tolhuisen ML, Alves H, Weterings AJ, Kirkels EL, Voogd EJ, Schupp LM, Collette SL, Groot AE, LeCouffe NE, Konduri PR, Prasetya H, Arrarte- Terreros N, Ramos LA, Brown MM, Liebig T, van der Heijden E, Ghannouti N, Fleitour N, Hooijenga I, Puppels C, Pellikaan W, Geerling A, Lindl-Velema A, van Vemde G, de Ridder A, Greebe P, de Bont- Stikkelbroeck J, de Meris J, Haaglanden MC, Janssen K, Licher S, Boodt N, Ros A, Venema E, Slokkers I, Ganpat RJ, Mulder M, Saiedie N, Heshmatollah A, Schipperen S, Vinken S, van Boxtel T, Koets J, Boers M, Santos E, Borst J, Jansen I, Kappelhof M, Lucas M, Geuskens RR, Sales Barros R. Determinants of Symptomatic Intracranial Hemorrhage After Endovascular Stroke Treatment: A Retrospective Cohort Study. Stroke 2022; 53:2818-2827. [PMID: 35674042 PMCID: PMC9389940 DOI: 10.1161/strokeaha.121.036195] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Symptomatic intracranial hemorrhage (sICH) is a serious complication after endovascular treatment for ischemic stroke. We aimed to identify determinants of its occurrence and location.
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Affiliation(s)
- Wouter van der Steen
- Department of Neurology (W.v.d.S., N.A.M.v.d.E., V.C., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine (W.v.d.S., N.A.M.v.d.E., V.C., P.J.v.D., A.v.d.L., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Nadinda A.M. van der Ende
- Department of Neurology (W.v.d.S., N.A.M.v.d.E., V.C., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine (W.v.d.S., N.A.M.v.d.E., V.C., P.J.v.D., A.v.d.L., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Katinka R. van Kranendonk
- Department of Radiology and Nuclear Medicine (K.R.v.K., C.B.L.M.M.), Maastricht University Medical Center, the Netherlands
| | - Vicky Chalos
- Department of Neurology (W.v.d.S., N.A.M.v.d.E., V.C., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine (W.v.d.S., N.A.M.v.d.E., V.C., P.J.v.D., A.v.d.L., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Public Health (V.C., H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Robert J. van Oostenbrugge
- Amsterdam University Medical Center, University of Amsterdam, the Netherlands. Department of Neurology (R.J.v.O.), Maastricht University Medical Center, the Netherlands
| | - Wim H. van Zwam
- Department of Radiology and Nuclear Medicine (W.H.v.Z.), Maastricht University Medical Center, the Netherlands
| | - Yvo B.W.E.M. Roos
- Department of Neurology (Y.B.W.E.M.R.), Maastricht University Medical Center, the Netherlands
| | - Pieter J. van Doormaal
- Department of Radiology and Nuclear Medicine (W.v.d.S., N.A.M.v.d.E., V.C., P.J.v.D., A.v.d.L., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Adriaan C.G.M. van Es
- Department of Radiology, Leiden University Medical Center, the Netherlands (A.C.G.M.v.E.)
| | - Hester F. Lingsma
- Department of Public Health (V.C., H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Charles B.L.M. Majoie
- Department of Radiology and Nuclear Medicine (K.R.v.K., C.B.L.M.M.), Maastricht University Medical Center, the Netherlands
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine (W.v.d.S., N.A.M.v.d.E., V.C., P.J.v.D., A.v.d.L., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Diederik W.J. Dippel
- Department of Neurology (W.v.d.S., N.A.M.v.d.E., V.C., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Bob Roozenbeek
- Department of Neurology (W.v.d.S., N.A.M.v.d.E., V.C., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine (W.v.d.S., N.A.M.v.d.E., V.C., P.J.v.D., A.v.d.L., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Kondo R, Ishihara S, Uemiya N, Kakehi Y, Nakadate M, Singu T, Tsuzuki N, Tokushige K. Endovascular Treatment for Acute Ischaemic Stroke Caused by Vertebral Artery Dissection: A Report of Three Cases and Literature Review. NMC Case Rep J 2022; 8:817-825. [PMID: 35079554 PMCID: PMC8769423 DOI: 10.2176/nmccrj.cr.2021-0268] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/20/2021] [Indexed: 11/20/2022] Open
Abstract
Vertebrobasilar artery dissection is an uncommon cause of acute ischaemic stroke (AIS). Optimal endovascular management has not been established. This study aimed to share our experience with endovascular reperfusion therapy for vertebrobasilar artery occlusion due to vertebral artery dissection (VAD). We retrospectively reviewed 134 consecutive patients with AIS who received urgent endovascular reperfusion therapy between November 2017 and November 2019. Three patients diagnosed with VAD were investigated. The evaluation included mechanisms of vertebrobasilar artery occlusion due to VAD, variations in endovascular procedures, and functional outcomes. Dissections at the V3, V4 and extension of V3 to V4 segments were seen in one patient each. The mechanism of AIS was different in each patient: occlusion of the distal non-dissected artery due to an embolus from the dissection site (distal occlusion), haemodynamic collapse of the entire vertebrobasilar artery system due to the arterial dissection itself (local occlusion), or coexistence of distal occlusion and local occlusion (tandem occlusion). The endovascular reperfusion therapy was performed corresponding to the abovementioned mechanisms: mechanical thrombectomy for distal occlusion, stenting for local occlusion, and a combination of thrombectomy and stenting for tandem occlusion. In all three patients, effective recanalization and functional independence (modified Rankin Scale scores of 0–2 at 90 days after the onset) were achieved. Endovascular treatment corresponding to the individual mechanism of AIS may improve patient outcomes.
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Affiliation(s)
- Ryushi Kondo
- Department of Neuroendovascular Therapy, Saitama Sekishinkai Hospital, Sayama, Saitama, Japan
| | - Shoichiro Ishihara
- Department of Neuroendovascular Therapy, Saitama Sekishinkai Hospital, Sayama, Saitama, Japan
| | - Nahoko Uemiya
- Department of Neuroendovascular Therapy, Saitama Sekishinkai Hospital, Sayama, Saitama, Japan
| | - Yoshiaki Kakehi
- Department of Neuroendovascular Therapy, Saitama Sekishinkai Hospital, Sayama, Saitama, Japan
| | - Masashi Nakadate
- Department of Neuroendovascular Therapy, Saitama Sekishinkai Hospital, Sayama, Saitama, Japan
| | - Takaomi Singu
- Department of Neuroendovascular Therapy, Saitama Sekishinkai Hospital, Sayama, Saitama, Japan
| | - Nobusuke Tsuzuki
- Department of Neurosurgery, Saitama Sekishinkai Hospital, Sayama, Saitama, Japan
| | - Kazuo Tokushige
- Department of Neurosurgery, Saitama Sekishinkai Hospital, Sayama, Saitama, Japan
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7
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Tarsia J, Vidal G, Zweifler RM. Arterial Dissection, Fibromuscular Dysplasia, and Carotid Webs. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00035-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Cucchiara BL, Kasner SE. Treatment of “Other” Stroke Etiologies. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00058-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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9
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Cheng Z, Rajah GB, Gao J, Geng X, Ding Y. Passing Extracranial Artery Occlusion by Intermediate Catheter With Expanding Microballoon (PEACE): A Novel Endovascular Therapy in Acute Tandem Occlusion Stroke. J Endovasc Ther 2021; 29:790-797. [PMID: 34894849 DOI: 10.1177/15266028211064818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Endovascular treatment of atherosclerotic tandem occlusions in acute ischemic stroke (AIS) is a matter of debate. This article reports a single-center experience using an intermediate catheter with microballoon for treatment of tandem occlusions. METHODS A total of 151 AIS patients with large vessel occlusion received endovascular therapy and a consecutive series of patients (n = 26) who suffered from tandem cervical intracranial occlusions were treated using the Passing Extracranial Artery Occlusion by Intermediate Catheter with Expanding Microballoon (PEACE) technique. Intracranial recanalization was achieved by aspiration or stent retriever and then emergency stenting was performed for extracranial internal carotid artery (ICA) lesion. Demographic, clinical characteristics, procedural details of endovascular therapy, and prognosis outcome were assessed. The outcomes of tandem occlusion group were compared with isolated intracranial occlusion group (n = 122) and previous studies. RESULTS As compared to isolated intracranial occlusion groups, only a few patients suffered from atrial fibrillation (7.7% vs 38.5%, p<0.01) in tandem occlusions group. A larger proportion of patients (61.5% vs 29.5%) had tandem occlusions in which extracranial ICA occlusion was combined with intracranial terminus occlusion in ICA (p<0.01). 46.2% of tandem occlusions patients achieved intracranial recanalization by aspiration alone versus 15.6% in patients with isolated intracranial occlusion (p<0.01). In tandem occlusion patients treated with PEACE, 92.3% achieved successful reperfusion (thrombolysis in cerebral infarct [TICI] ≥2b). The median time from puncture to recanalization was 51 minutes (interquartile range [IQR], 41-66). 67.6% favorable functional prognosis (modified Rankin score [mRS], 0-2) was seen, with 11.5% mortality and 3.8% of symptomatic intracerebral hemorrhage (sICH) at 90 days. These outcomes are all consistent or better than previously reported studies performed for tandem occlusion. CONCLUSIONS Endovascular therapy using the PEACE technique with intermediate catheter and lined expanding microballoon is safe, efficient, and fast in the treatment of atherosclerotic tandem occlusion patients.
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Affiliation(s)
- Zhe Cheng
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Gary B Rajah
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.,Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, NY, USA.,Department of Neurosurgery, Munson Healthcare, Traverse City, MI, USA
| | - Jie Gao
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Xiaokun Geng
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China.,China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Yuchuan Ding
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, School of Medicine, Wayne State University, Detroit, MI, USA
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10
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Fontaine L, Sibon I, Raposo N, Albucher JF, Mazighi M, Rousseau V, Darcourt J, Thalamas C, Drif A, Sommet A, Viguier A, Guenego A, Januel AC, Calvière L, Menegon P, Bonneville F, Tourdias T, Albers GW, Cognard C, Olivot JM. ASCOD Phenotyping of Stroke With Anterior Large Vessel Occlusion Treated by Mechanical Thrombectomy. Stroke 2021; 52:e769-e772. [PMID: 34702062 DOI: 10.1161/strokeaha.121.035282] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Determining the mechanism of large vessel occlusion related acute ischemic stroke is of major importance to initiate a tailored secondary prevention strategy. We investigated using the atherosclerosis, small vessel disease, cardiac source, other cause, dissection (ASCOD) classification the distribution of the causes of large vessel occlusion related acute ischemic stroke treated by mechanical thrombectomy. METHODS This was a predefined substudy of the FRAME (French Acute Multimodal Imaging to Select Patient for Mechanical Thrombectomy). Each patient underwent a systematic etiological workup including brain and vascular imaging, electrocardiogram monitoring lasting at least 24 hours and routine blood tests. Stroke mechanisms were systematically evaluated using the atherosclerosis, small vessel disease, cardiac source, other cause, dissection grading system at 3 months. We defined single potential cause by one cause graded 1 in a single domain, possible cause as a cause graded 1 or 2 regardless of overlap, and no identified cause without grade 1 nor 2 causes. RESULTS A total of 215 patients (mean age 70±14; 50% male) were included. A single potential cause was identified in 148 (69%). Cardio-embolism (53%) was the most frequent, followed by atherosclerosis (9%), dissection (5%) and other causes (1%). Atrial fibrillation accounted for 88% of C1. Overlap between grade 1 causes was uncommon (3%). Possible causes were identified in 168 patients (83%) and 16 (7%) had no cause identified after the initial evaluation. CONCLUSIONS Cardio-embolism, especially atrial fibrillation, was the major cause of large vessel occlusion related acute ischemic stroke. This finding emphasizes the yield of paroxysmal atrial fibrillation detection in those patients. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03045146.
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Affiliation(s)
- Louis Fontaine
- Acute Stroke Unit (L.F., N.R., J.-F.A., A.V., L.C., J.-M.O.), Toulouse University Hospital, France.,Clinical Investigation Center (L.F., N.R., J.-F.A., V.R., C.T., A.D., A.S., A.V., L.C., J.-M.O.), Toulouse University Hospital, France.,Toulouse Neuro Imaging Center (L.F., N.R., J.-F.A., A.V., L.C., J.-M.O.), Toulouse University Hospital, France
| | - Igor Sibon
- Stroke Unit (I.S.), Bordeaux University Hospital, France
| | - Nicolas Raposo
- Acute Stroke Unit (L.F., N.R., J.-F.A., A.V., L.C., J.-M.O.), Toulouse University Hospital, France.,Clinical Investigation Center (L.F., N.R., J.-F.A., V.R., C.T., A.D., A.S., A.V., L.C., J.-M.O.), Toulouse University Hospital, France.,Toulouse Neuro Imaging Center (L.F., N.R., J.-F.A., A.V., L.C., J.-M.O.), Toulouse University Hospital, France
| | - Jean-François Albucher
- Acute Stroke Unit (L.F., N.R., J.-F.A., A.V., L.C., J.-M.O.), Toulouse University Hospital, France.,Clinical Investigation Center (L.F., N.R., J.-F.A., V.R., C.T., A.D., A.S., A.V., L.C., J.-M.O.), Toulouse University Hospital, France.,Toulouse Neuro Imaging Center (L.F., N.R., J.-F.A., A.V., L.C., J.-M.O.), Toulouse University Hospital, France
| | - Michael Mazighi
- University of Paris U1148, Rothschild Foundation Hospital, France (M.M.)
| | - Vanessa Rousseau
- Clinical Investigation Center (L.F., N.R., J.-F.A., V.R., C.T., A.D., A.S., A.V., L.C., J.-M.O.), Toulouse University Hospital, France
| | - Jean Darcourt
- Department of Neuroradiology (J.D., A.-C.J., F.B., C.C.), Toulouse University Hospital, France
| | - Claire Thalamas
- Clinical Investigation Center (L.F., N.R., J.-F.A., V.R., C.T., A.D., A.S., A.V., L.C., J.-M.O.), Toulouse University Hospital, France
| | - Amel Drif
- Clinical Investigation Center (L.F., N.R., J.-F.A., V.R., C.T., A.D., A.S., A.V., L.C., J.-M.O.), Toulouse University Hospital, France
| | - Agnes Sommet
- Clinical Investigation Center (L.F., N.R., J.-F.A., V.R., C.T., A.D., A.S., A.V., L.C., J.-M.O.), Toulouse University Hospital, France
| | - Alain Viguier
- Acute Stroke Unit (L.F., N.R., J.-F.A., A.V., L.C., J.-M.O.), Toulouse University Hospital, France.,Clinical Investigation Center (L.F., N.R., J.-F.A., V.R., C.T., A.D., A.S., A.V., L.C., J.-M.O.), Toulouse University Hospital, France.,Toulouse Neuro Imaging Center (L.F., N.R., J.-F.A., A.V., L.C., J.-M.O.), Toulouse University Hospital, France
| | - Adrien Guenego
- Stanford Stroke Center, Stanford University, CA (A.G., G.W.A.)
| | - Anne-Christine Januel
- Department of Neuroradiology (J.D., A.-C.J., F.B., C.C.), Toulouse University Hospital, France
| | - Lionel Calvière
- Acute Stroke Unit (L.F., N.R., J.-F.A., A.V., L.C., J.-M.O.), Toulouse University Hospital, France.,Clinical Investigation Center (L.F., N.R., J.-F.A., V.R., C.T., A.D., A.S., A.V., L.C., J.-M.O.), Toulouse University Hospital, France.,Toulouse Neuro Imaging Center (L.F., N.R., J.-F.A., A.V., L.C., J.-M.O.), Toulouse University Hospital, France
| | - Patrice Menegon
- Department of Neuroradiology (P.M., T.T.), Bordeaux University Hospital, France
| | - Fabrice Bonneville
- Department of Neuroradiology (J.D., A.-C.J., F.B., C.C.), Toulouse University Hospital, France
| | - Thomas Tourdias
- Department of Neuroradiology (P.M., T.T.), Bordeaux University Hospital, France
| | | | - Christophe Cognard
- Department of Neuroradiology (J.D., A.-C.J., F.B., C.C.), Toulouse University Hospital, France
| | - Jean-Marc Olivot
- Acute Stroke Unit (L.F., N.R., J.-F.A., A.V., L.C., J.-M.O.), Toulouse University Hospital, France.,Clinical Investigation Center (L.F., N.R., J.-F.A., V.R., C.T., A.D., A.S., A.V., L.C., J.-M.O.), Toulouse University Hospital, France.,Toulouse Neuro Imaging Center (L.F., N.R., J.-F.A., A.V., L.C., J.-M.O.), Toulouse University Hospital, France
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11
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Marnat G, Sibon I, Bourcier R, Anadani M, Gariel F, Labreuche J, Kyheng M, Mazighi M, Dargazanli C, Piotin M, Consoli A, Blanc R, Anxionnat R, Audibert G, Richard S, Lapergue B, Gory B. Thrombolysis Improves Reperfusion and the Clinical Outcome in Tandem Occlusion Stroke Related to Cervical Dissection: TITAN and ETIS Pooled Analysis. J Stroke 2021; 23:411-419. [PMID: 34649385 PMCID: PMC8521253 DOI: 10.5853/jos.2020.04889] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 09/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Purpose Despite the widespread adoption of mechanical thrombectomy (MT) for the treatment of large vessel occlusion stroke (LVOS) in the anterior circulation, the optimal strategy for the treatment tandem occlusion related to cervical internal carotid artery (ICA) dissection is still debated. This individual patient pooled analysis investigated the safety and efficacy of prior intravenous thrombolysis (IVT) in anterior circulation tandem occlusion related to cervical ICA dissection treated with MT.
Methods We performed a retrospective analysis of two merged prospective multicenter international real-world observational registries: Endovascular Treatment in Ischemic Stroke (ETIS) and Thrombectomy In TANdem occlusions (TITAN) registries. Data from MT performed in the treatment of tandem LVOS related to cervical ICA dissection between January 2012 and December 2019 at 24 comprehensive stroke centers were analyzed. The primary endpoint was a favorable outcome defined as 90-day modified Rankin Scale (mRS) score of 0–2.
Results The study included 144 patients with tandem occlusion LVOS due to cervical ICA dissection, of whom 94 (65.3%) received IVT before MT. Prior IVT was significantly associated with a better clinical outcome considering the mRS shift analysis (common odds ratio, 2.59; 95% confidence interval [CI], 1.35 to 4.93; P=0.004 for a 1-point improvement) and excellent outcome (90-day mRS 0–1) (adjusted odds ratio [aOR], 4.23; 95% CI, 1.60 to 11.18). IVT was also associated with a higher rate of intracranial successful reperfusion (83.0% vs. 64.0%; aOR, 2.70; 95% CI, 1.21 to 6.03) and a lower rate of symptomatic intracranial hemorrhage (4.3% vs. 14.8%; aOR, 0.21; 95% CI, 0.05 to 0.80).
Conclusions Prior IVT before MT for the treatment of tandem occlusion related to cervical ICA dissection was safe and associated with an improved 90-day functional outcome.
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Affiliation(s)
- Gaultier Marnat
- Department of Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | - Igor Sibon
- Department of Neurology, University Hospital of Bordeaux, Bordeaux, France
| | - Romain Bourcier
- Department of Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Mohammad Anadani
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Florent Gariel
- Department of Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | | | - Maeva Kyheng
- Department of Biostatistics, University of Lille, Lille, France
| | - Mikael Mazighi
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Cyril Dargazanli
- Department of Neuroradiology, CHRU Gui-de-Chauliac, Montpellier, France
| | - Michel Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Arturo Consoli
- Department of Neuroradiology, Foch Hospital, Versailles Saint-Quentin-en-Yvelines University, Suresnes, France
| | - Raphaël Blanc
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - René Anxionnat
- Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, CHRU-Nancy, Nancy, France.,Université de Lorraine, IADI, INSERM U1254, Nancy, France
| | - Gérard Audibert
- Department of Anesthesiology and Intensive Care, University of Lorraine, University Hospital of Nancy, Nancy, France
| | - Sébastien Richard
- Stroke Unit, Department of Neurology, University of Lorraine, University Hospital of Nancy, and INSERM U1116, Nancy, France
| | - Bertrand Lapergue
- Department of Neurology, Foch Hospital, Versailles Saint-Quentin-en-Yvelines University, Suresnes, France
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, CHRU-Nancy, Nancy, France.,Université de Lorraine, IADI, INSERM U1254, Nancy, France
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- Department of Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
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12
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Anadani M, Marnat G, Consoli A, Papanagiotou P, Nogueira RG, Siddiqui A, Ribo M, Spiotta AM, Bourcier R, Kyheng M, Labreuche J, de Havenon A, Sibon I, Dargazanli C, Arquizan C, Cognard C, Olivot JM, Anxionnat R, Audibert G, Mazighi M, Blanc R, Lapergue B, Richard S, Gory B. Endovascular Therapy of Anterior Circulation Tandem Occlusions: Pooled Analysis From the TITAN and ETIS Registries. Stroke 2021; 52:3097-3105. [PMID: 34372671 DOI: 10.1161/strokeaha.120.033032] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Endovascular therapy for tandem occlusion strokes of the anterior circulation is an effective and safe treatment. The best treatment approach for the cervical internal carotid artery (ICA) lesion is still unknown. In this study, we aimed to compare the functional and safety outcomes between different treatment approaches for the cervical ICA lesion during endovascular therapy for acute ischemic strokes due to tandem occlusion in current clinical practice. METHODS Individual patients' data were pooled from the French prospective multicenter observational ETIS (Endovascular Treatment in Ischemic Stroke) and the international TITAN (Thrombectomy in Tandem Lesions) registries. TITAN enrolled patients from January 2012 to September 2016, and ETIS from January 2013 to July 2019. Patients with acute ischemic stroke due to anterior circulation tandem occlusion who were treated with endovascular therapy were included. Patients were divided based on the cervical ICA lesion treatment into stent and no-stent groups. Outcomes were compared between the two treatment groups using propensity score methods. RESULTS A total of 603 patients were included, of whom 341 were treated with acute cervical ICA stenting. In unadjusted analysis, the stent group had higher rate of favorable outcome (90-day modified Rankin Scale score, 0-2; 57% versus 45%) and excellent outcome (90-day modified Rankin Scale score, 0-1; 40% versus 27%) compared with the no-stent group. In inverse probability of treatment weighting propensity score-adjusted analyses, stent group had higher odds of favorable outcome (adjusted odds ratio, 1.09 [95% CI, 1.01-1.19]; P=0.036) and successful reperfusion (modified Thrombolysis in Cerebral Ischemia score, 2b-3; adjusted odds ratio, 1.19 [95% CI, 1.11-1.27]; P<0.001). However, stent group had higher odds of any intracerebral hemorrhage (adjusted odds ratio, 1.10 [95%, 1.02-1.19]; P=0.017) but not higher rate of symptomatic intracerebral hemorrhage or parenchymal hemorrhage type 2. Subgroup analysis demonstrated heterogeneity according to the lesion type (atherosclerosis versus dissection; P for heterogeneity, 0.01), and the benefit from acute carotid stenting was only observed for patients with atherosclerosis. CONCLUSIONS Patients treated with acute cervical ICA stenting for tandem occlusion strokes had higher odds of 90-day favorable outcome, despite higher odds of intracerebral hemorrhage; however, most of the intracerebral hemorrhages were asymptomatic.
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Affiliation(s)
- Mohammad Anadani
- Department of Neurology, Washington University School of Medicine, St. Louis (M.A., A.d.H.).,Department of Neurosurgery, Medical University of South Carolina, Charleston (A.M.S., M.A.)
| | - Gaultier Marnat
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, France. (G.M.)
| | - Arturo Consoli
- Department of Diagnostic and Interventional Neuroradiology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France. (A.C.)
| | - Panagiotis Papanagiotou
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Germany (P.P.)
| | - Raul G Nogueira
- Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta (R.G.N.)
| | - Adnan Siddiqui
- Department of Neurosurgery, State University of New York, Buffalo (A.S.)
| | - Marc Ribo
- Department of Neurology, Hospital Vall D'Hebron, Barcelona, Spain (M.R.)
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston (A.M.S., M.A.)
| | - Romain Bourcier
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, L'institut du thorax, INSERM 1087, CNRS, Université de Nantes, France (R.B.)
| | - Maeva Kyheng
- University Lille, CHU Lille, EA 2694, Santé Publique: épidémiologie et Qualité des Soins, France (M.K., J.L.)
| | - Julien Labreuche
- University Lille, CHU Lille, EA 2694, Santé Publique: épidémiologie et Qualité des Soins, France (M.K., J.L.)
| | - Adam de Havenon
- Department of Neurology, Washington University School of Medicine, St. Louis (M.A., A.d.H.)
| | - Igor Sibon
- Department of Neurology, Stroke Center, University Hospital of Bordeaux, France. (I.S.)
| | - Cyril Dargazanli
- Department of Interventional Neuroradiology, CHRU Gui de Chauliac, Montpellier, France. (C.D.)
| | - Caroline Arquizan
- Department of Neurology, CHRU Gui de Chauliac, Montpellier, France. (C.A.)
| | - Christophe Cognard
- Department of Neuroradiology, University Hospital of Toulouse, France. (C.C.)
| | - Jean-Marc Olivot
- Department of Stroke Unit, Department of Neurology, University Hospital of Toulouse, France. (J.-M.O.)
| | - René Anxionnat
- Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, CHRU-Nancy, France. (R.A., B.G.).,IADI, INSERM U1254, Université de Lorraine, Nancy, France (R.A., B.G.)
| | - Gérard Audibert
- Department of Anesthesiology and Surgical Intensive Care, Université de Lorraine, CHRU-Nancy, France. (G.A.)
| | - Mikaël Mazighi
- Department of Interventional Neuroradiology, Rothschild Foundation, University of Paris, INSERM U1148, France (M.M., R.B.)
| | - Raphaël Blanc
- Department of Interventional Neuroradiology, Rothschild Foundation, University of Paris, INSERM U1148, France (M.M., R.B.)
| | - Bertrand Lapergue
- Department of Neurology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France. (B.L.)
| | - Sébastien Richard
- Stroke Unit, Department of Neurology, Université de Lorraine, CHRU-Nancy, France. (S.R.).,INSERM U1116, CHRU-Nancy, France. (S.R.)
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, CHRU-Nancy, France. (R.A., B.G.).,IADI, INSERM U1254, Université de Lorraine, Nancy, France (R.A., B.G.)
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13
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Da Ros V, Scaggiante J, Pitocchi F, Sallustio F, Lattanzi S, Umana GE, Chaurasia B, Bandettini di Poggio M, Toscano G, Rolla Bigliani C, Ruggiero M, Haznedari N, Sgreccia A, Sanfilippo G, Diomedi M, Finocchi C, Floris R. Mechanical thrombectomy in acute ischemic stroke with tandem occlusions: impact of extracranial carotid lesion etiology on endovascular management and outcome. Neurosurg Focus 2021; 51:E6. [PMID: 34198245 DOI: 10.3171/2021.4.focus21111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/07/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Different etiologies of extracranial internal carotid artery steno-occlusive lesions (ECLs) in patients with acute ischemic stroke (AIS) and tandem occlusion (TO) have been pooled together in randomized trials. However, carotid atherosclerosis (CA) and carotid dissection (CD), the two most common ECL etiologies, are distinct nosological entities. The authors aimed to determine if ECL etiology has impacts on the endovascular management and outcome of patients with TO. METHODS A multicenter, retrospective study of prospectively collected data was conducted. AIS patients were included who had TO due to internal CA or CD and ipsilateral M1 middle cerebral artery occlusion and underwent endovascular treatment (EVT). Comparative analyses including demographic data, safety, successful recanalization rates, and clinical outcome were performed according to EVT and ECL etiology. RESULTS In total, 214 AIS patients with TOs were included (77.6% CA related, 22.4% CD related). Patients treated with a retrograde approach were more often functionally independent at 3 months than patients treated with an antegrade approach (OR 0.6, 95% CI 0.4-0.9). Patients with CD-related TOs achieved 90-day clinical independence more often than patients with CA-related TOs (OR 1.4, 95% CI 1.1-2.0). Emergency stenting use was associated with good 3-month clinical outcome only in patients with CA-related TOs (OR 1.4, 95% CI 1.1-2.1). Symptomatic intracranial hemorrhage (sICH) occurred in 10.7% of patients, without differences associated with ECL etiology. CONCLUSIONS ECL etiology impacts both EVT approach and clinical outcome in patients with TOs. Patients with CD-related TO achieved higher 3-month functional independence rates than patients with CA-related TOs. A retrograde approach can be desirable for both CA- and CD-related TOs, and emergency stenting is likely better justified in CA-related TOs.
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Affiliation(s)
- Valerio Da Ros
- 1Department of Biomedicine, Interventional Neuroradiology Unit, University of Rome Tor Vergata, Rome
| | - Jacopo Scaggiante
- 1Department of Biomedicine, Interventional Neuroradiology Unit, University of Rome Tor Vergata, Rome.,13Medical University of South Carolina, Division of Neuroradiology, Charleston, South Carolina
| | - Francesca Pitocchi
- 1Department of Biomedicine, Interventional Neuroradiology Unit, University of Rome Tor Vergata, Rome
| | | | - Simona Lattanzi
- 3Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona
| | - Giuseppe Emmanuele Umana
- 4Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Bipin Chaurasia
- 5Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Monica Bandettini di Poggio
- 6Ospedale Policlinico San Martino, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova
| | | | - Claudia Rolla Bigliani
- 8Department of Diagnostic and Interventional Neuroradiology, Policlinico Universitario San Martino, Genova
| | | | | | - Alessandro Sgreccia
- 10Department of Clinical Neuroradiology and Interventional Neuroradiology, AOU Ospedali Riuniti, Ancona
| | - Giuseppina Sanfilippo
- 11Department of Diagnostic and Interventional Radiology and Neuroradiology, IRCCS Policlinico San Matteo, Pavia
| | - Marina Diomedi
- 12Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; and
| | - Cinzia Finocchi
- 6Ospedale Policlinico San Martino, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova
| | - Roberto Floris
- 1Department of Biomedicine, Interventional Neuroradiology Unit, University of Rome Tor Vergata, Rome
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14
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Safety and outcome of mechanical thrombectomy in ischaemic stroke related to carotid artery dissection. J Neurol 2021; 269:772-779. [PMID: 34184125 DOI: 10.1007/s00415-021-10656-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/30/2021] [Accepted: 06/09/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND The net clinical benefit of mechanical thrombectomy (MT) in patients with anterior circulation ischaemic stroke associated with large vessel occlusion (AIS-LVO) related to carotid artery dissection (CAD) is uncertain. The aim of the study was to investigate the safety and clinical outcomes of patients treated by MT for a CAD-related stroke. METHODS We included consecutive patients with AIS-LVO treated by MT between 1st 2015 and January 1st 2020 at Lille University Hospital. We compared the safety and clinical outcomes, including successful recanalisation, defined as a modified thrombolysis in cerebral infarction (mTICI) ≥ 2b and favourable functional outcome at 3 months (defined as a modified Rankin Scale (mRS) ≤ 2 or equal to pre-stroke), in patients with CAD-related stroke versus patients with other aetiologies. RESULTS We included 1422 patients, among them, 43 patients with CAD-related AIS-LVO were matched to 86 patients with other aetiologies. Procedural complications, sICH (ECASS-3 criteria) and mortality rates were similar in the two groups (OR 0.85, 95% CI 0.21-3.49, p = 0.82; OR 1.54 95% CI 0.33-2.79, p = 0.58; OR 0.18 95% CI 0.02-1.46, p = 0.11, respectively), as well as the rates of intracranial angiographic successful recanalisation and favourable functional outcome (OR 0.67 (95% CI 0.26-1.73, p = 0.41; OR 1.26 (95% CI 0.61-2.64, p = 0.53). In patients with CAD-related stroke, intracranial angiographic success after MT was significantly associated with favourable functional outcome. CONCLUSIONS In patients with AIS-LVO related to CAD, safety profiles and clinical outcomes after MT are similar compared to matched patients with other stroke aetiologies.
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Schlemm L, von Rennenberg R, Siebert E, Bohner G, Flottmann F, Petzold GC, Thomalla G, Endres M, Nolte CH. Mechanical thrombectomy in patients with cervical artery dissection and stroke in the anterior or posterior circulation - a multicenter analysis from the German Stroke Registry. Neurol Res Pract 2021; 3:20. [PMID: 33934710 PMCID: PMC8091690 DOI: 10.1186/s42466-021-00119-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/16/2021] [Indexed: 11/25/2022] Open
Abstract
Background Cervical artery dissection (CAD) is a rare cause of acute ischemic stroke (AIS) with large vessel occlusion (LVO) and may constitute a challenge for mechanical thrombectomy (MT). We compared procedural characteristics, reperfusion rates, and clinical outcome in AIS patients undergoing MT with and without CAD. Methods We performed a pre-specified analysis of patients registered within the German Stroke Registry, a prospectively maintained multicenter registry of consecutive patients with AIS patients treated by MT. Procedural characteristics included time periods and additional application of medication. Results Of 2589 patients, 62 (2.4%) were diagnosed with CAD. CAD patients were younger, had lower rates of known vascular risk factors and larger baseline stroke volumes. MT in CAD patients took significantly longer (median [IQR] groin-puncture-to-flow restoration time: 98 [67–136] versus 70 [45–100] minutes; p < 0.001) and more often required use of intra-arterial medication (34.4% versus 15.6%; p < 0.001). Reperfusion success (modified Treatment in Cerebral Infarction score 2b-3: 85.2% versus 83.3%, p = 0.690) and favorable functional outcome after 3 months (modified Rankin Scale score ≤ 2: 70.9% versus 36.4%, adjusted p = 0.086) did not differ significantly between patients with and without CAD. The latter findings held true for both CAD in the anterior and posterior circulation. Conclusion CAD in AIS requiring MT is rare. MT in patients with CAD constitutes a particular procedural challenge, but still achieves favorable radiological and functional outcomes in most patients. Our data provide indirect evidence that MT is of clinical benefit in patients with AIS due to LVO and CAD. Supplementary Information The online version contains supplementary material available at 10.1186/s42466-021-00119-y.
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Affiliation(s)
- Ludwig Schlemm
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany
| | - Regina von Rennenberg
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany.,DZNE (German Center for Neurodegenerative Diseases), Partner Site Berlin, Berlin, Germany
| | - Eberhard Siebert
- Berlin Institute of Health (BIH), Berlin, Germany.,Department of Neuroradiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu, Berlin, Germany
| | - Georg Bohner
- Berlin Institute of Health (BIH), Berlin, Germany.,Department of Neuroradiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu, Berlin, Germany
| | - Fabian Flottmann
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Martinistr 52, 20246, Hamburg, Germany
| | - Gabor C Petzold
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Bonn, Germany.,Department of Neurology, Division of Vascular Neurology, University Hospital Bonn, Bonn, Germany
| | - Götz Thomalla
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurologie, Martinistr. 52, 20246, Hamburg, Germany
| | - Matthias Endres
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany.,DZNE (German Center for Neurodegenerative Diseases), Partner Site Berlin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Christian H Nolte
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany. .,Berlin Institute of Health (BIH), Berlin, Germany. .,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany. .,DZNE (German Center for Neurodegenerative Diseases), Partner Site Berlin, Berlin, Germany. .,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany. .,Department of Neurology, Charite - Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
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Marnat G, Lapergue B, Sibon I, Gariel F, Bourcier R, Kyheng M, Labreuche J, Dargazanli C, Consoli A, Blanc R, Piotin M, Mazighi M, Richard S, Gory B, Redjem H, Escalard S, Desilles JP, Redjem H, Ciccio G, Smajda S, Fahed R, Obadia M, Sabben C, Corabianu O, de Broucker T, Smadja D, Alamowitch S, Ille O, Manchon E, Garcia PY, Taylor G, Ben Maacha M, Bourdain F, Decroix JP, Wang A, Evrard S, Tchikviladze M, Coskun O, Di Maria F, Rodesh G, Leguen M, Tisserand M, Pico F, Rakotoharinandrasana H, Tassan P, Poll R, Nighoghossian N, Riva R, Eker O, turjman F, Derex L, Cho TH, Mechtouff L, Claire Lukaszewicz A, Philippeau F, Cakmak S, Blanc-Lasserre K, Vallet AE, Barreau X, Berge J, Menegon P, Lucas L, Olindo S, Renou P, Sagnier S, Poli M, Debruxelles S, Rouanet F, Tourdias T, Liegey JS, Detraz L, Daumas-Duport B, Alexandre PL, Roy M, Lenoble C, L’allinec V, Girot JB, Desal H, Bracard S, Anxionnat R, Braun M, Derelle AL, Tonnelet R, Liao L, Zhu F, Schmitt E, Planel S, Humbertjean L, Mione G, Lacour JC, Bonnerot M, Riou-Comte N, Costalat V, Gascou G, Lefèvre PH, Derraz I, Riquelme C, Arquizan C, Gaillard N, Mourand I, Corti L, Cagnazzo F, Anadani M, Spiotta A, Alawieh A, Turjman F, Haussen D, Nogueira R, Papanagiotou P, Siddiqui AH, Dorn F, Cognard C, Ribo M, Psychogios M, Labeyrie MA, Biondi A, Andrew Grossberg J, Guenego A, Darcourt J, Vukasinovic I, Pomero E, Davies J, Renieri L, Hecker C, Muchada Muchada M, Houdart E, Turner R, Turk A, Chaudry I, Lockau J, Kastrup A, Behme D, Shallwani H, Christopher M, Mione G. Safety and Outcome of Carotid Dissection Stenting During the Treatment of Tandem Occlusions. Stroke 2020; 51:3713-3718. [DOI: 10.1161/strokeaha.120.030038] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background and Purpose:
The efficacy of endovascular therapy in patients with acute ischemic stroke due to tandem occlusion is comparable to that for isolated intracranial occlusion in the anterior circulation. However, the optimal management of acute cervical internal carotid artery lesions is unknown, especially in the setting of carotid dissection, but emergency carotid artery stenting (CAS) is frequently considered. We investigated the safety and efficacy of emergency CAS for carotid dissection in patients with acute stroke with tandem occlusion in current clinical practice.
Methods:
We retrospectively analyzed a prospectively maintained database composed of 2 merged multicenter international observational real-world registries (Endovascular Treatment in Ischemic Stroke and Thrombectomy in Tandem Lesion). Data from endovascular therapy performed in the treatment of tandem occlusions related to acute cervical carotid dissection between January 2012 and January 2019 at 24 comprehensive stroke centers were analyzed.
Results:
The study assessed 136 patients with tandem occlusion due to dissection, including 65 (47.8%) treated with emergency CAS and 71 (52.2%) without. The overall rates of favorable outcome (90-day modified Rankin Scale score, 0–2) and successful reperfusion (modified Thrombolysis in Cerebral Infarction, 2b–3) were 58.0% (n=76 [95% CI, 49.6%–66.5%]) and 77.9% (n=106 [95% CI, 71.0%–85.0%]), respectively. In subgroup analyses, the rate of successful reperfusion (89.2% versus 67.6%; adjusted odds ratio, 2.24 [95% CI, 1.33–3.77]) was higher after CAS, whereas the 90-day favorable outcome (54.3% versus 61.4%; adjusted odds ratio, 0.84 [95% CI, 0.58–1.22]), symptomatic intracerebral hemorrhage (sICH; 10.8% versus 5.6%; adjusted odds ratio, 1.59 [95% CI, 0.79–3.17]), and 90-day mortality (8.0% versus 5.8%; adjusted odds ratio, 1.00 [95% CI, 0.48–2.09]) did not differ. In sensitivity analyses of patients with successful intracranial reperfusion, CAS was not associated with an improved clinical outcome.
Conclusions:
Emergency stenting of the dissected cervical carotid artery during endovascular therapy for tandem occlusions seems safe, whatever the quality of the intracranial reperfusion.
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Affiliation(s)
- Gaultier Marnat
- Department of Neuroradiology, University Hospital of Bordeaux, France (G.M., F.G.)
| | - Bertrand Lapergue
- Department of Neurology, Foch Hospital, Versailles Saint-Quentin-en-Yvelines University, Suresnes, France (B.L.)
| | - Igor Sibon
- Department of Neurology, University Hospital of Bordeaux, France (I.S.)
| | - Florent Gariel
- Department of Neuroradiology, University Hospital of Bordeaux, France (G.M., F.G.)
| | - Romain Bourcier
- Department of Neuroradiology, University Hospital of Nantes, France (R.B.)
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (R.B., M.P., M.M.)
| | - Maeva Kyheng
- Université Lille, CHU Lille, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins—Lille—France (M.K., J.L.)
| | - Julien Labreuche
- Université Lille, CHU Lille, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins—Lille—France (M.K., J.L.)
| | - Cyril Dargazanli
- Department of Neuroradiology, CHRU Gui de Chauliac, Montpellier, France (C.D.)
| | - Arturo Consoli
- Department of Neuroradiology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France (A.C.)
| | | | - Michel Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (R.B., M.P., M.M.)
| | - Mikael Mazighi
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (R.B., M.P., M.M.)
| | - Sebastien Richard
- Université de Lorraine, CHRU-Nancy, Department of Neurology, Stroke Unit, F-54000 Nancy, France (S.R.)
- INSERM U1116, CHRU-Nancy, F-54000 Nancy, France (S.R.)
| | - Benjamin Gory
- Université de Lorraine, CHRU-Nancy, Department of Diagnostic and Therapeutic Neuroradiology, F-54000 Nancy, France (B.G.)
- Université de Lorraine, IADI, INSERM U1254, F-54000 Nancy, France (B.G.)
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Piñana C, Gramegna LL, Folleco E, Requena M, Hernandez D, Tomasello Weitz A. Preliminary Experience Using a Covered Stent Graft in Patients with Acute Ischemic Stroke and Carotid Tandem Lesion. Cardiovasc Intervent Radiol 2020; 43:1679-1686. [PMID: 32676962 DOI: 10.1007/s00270-020-02594-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 07/04/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Endovascular treatment with a covered heparin-bonded stent graft has been shown to be feasible and safe for treatment of peripheral artery disease, but its role in carotid disease remains unclear. The purpose of this study was to determine the feasibility and safety of a covered stent graft in treating cervical carotid artery disease in a consecutive series of patients with acute ischemic stroke (AIS) due to tandem lesion in a single high-volume Comprehensive Stroke Center. METHODS A retrospective review of all patients that underwent carotid endovascular interventions during mechanical thrombectomy for AIS using a self-expanding covered stent graft at Vall d'Hebron University Hospital between 2016 and 2018 was conducted. Patient clinical and angiographical characteristics as well as postoperative outcome and follow-up were recorded. RESULTS A total of eight patients were treated with the covered stents, and we observed significant improvement in stroke severity at 24 h in 5/8 patients (mean NIHSS 18 ± 5 vs 12 ± 8, p = 0.02). Successful recanalization (TICI 2b-3) after thrombectomy was achieved in 5/8 (62.5%) patients. One stent occluded during the procedure. At 3-month follow-up, stents were patent in three (37.5%) patients (two with mRS 3 and one with mRS 1). The stents of the remaining four patients (62.5%) were occluded (one with mRS 2 and three with mRS 4), although the patients did not show signs of stroke recurrence. CONCLUSION The preliminary results of our study show that the self-expanding covered stent graft did not achieve satisfactory patency at 90-days among patients with AIS and tandem lesions, suggesting that its use in the carotid circulation may not be recommended in the context of AIS.
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Affiliation(s)
- Carlos Piñana
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain.,Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Laura Ludovica Gramegna
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Edgar Folleco
- Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Manuel Requena
- Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain.,Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - David Hernandez
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain.,Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alejandro Tomasello Weitz
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Pg. Vall d'Hebron, 119-129, 08035, Barcelona, Spain. .,Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain.
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Farouk M, Sato K, Matsumoto Y, Tominaga T. Endovascular Treatment of Internal Carotid Artery Dissection Presenting with Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2020; 29:104592. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104592] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/23/2019] [Accepted: 12/03/2019] [Indexed: 01/18/2023] Open
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