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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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