TY - JOUR
T1 - Mechanical Thrombectomy for Acute Intracranial Carotid Occlusion with Patent Intracranial Arteries
T2 - The Italian Registry of Endovascular Treatment in Acute Stroke
AU - Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) Collaborators
AU - Sallustio, Fabrizio
AU - Saia, Valentina
AU - Marrama, Federico
AU - Pracucci, Giovanni
AU - Gandini, Roberto
AU - Koch, Giacomo
AU - Mascolo, Alfredo Paolo
AU - D’Agostino, Federica
AU - Rocco, Alessandro
AU - Argiro’, Renato
AU - Nezzo, Marco
AU - Morosetti, Daniele
AU - Wlderk, Andrea
AU - Da Ros, Valerio
AU - Diomedi, Marina
AU - Renieri, Leonardo
AU - Nencini, Patrizia
AU - Vallone, Stefano
AU - Zini, Andrea
AU - Bigliardi, Guido
AU - Caragliano, Antonio
AU - Francalanza, Isabella
AU - Bracco, Sandra
AU - Tassi, Rossana
AU - Bergui, Mauro
AU - Naldi, Andrea
AU - Saletti, Andrea
AU - De Vito, Alessandro
AU - Gasparotti, Roberto
AU - Magoni, Mauro
AU - Cirillo, Luigi
AU - Commodaro, Christian
AU - Biguzzi, Sara
AU - Castellan, Lucio
AU - Malfatto, Laura
AU - Menozzi, Roberto
AU - Grisendi, Ilaria
AU - Cosottini, Mirco
AU - Orlandi, Giovanni
AU - Comai, Alessio
AU - Franchini, Enrica
AU - D’Argento, Francesco
AU - Frisullo, Giovanni
AU - Puglielli, Edoardo
AU - Casalena, Alfonsina
AU - Sgreccia, Alessandro
AU - Tosi, Piera
AU - Nuzzi, Nunzio Paolo
AU - Marcheselli, Simona
AU - Sacco, Simona
N1 - Funding Information:
The project “Registro Nazionale Trattamento Ictus Acuto” (RFPS-2006-1-336562) was funded by grants from the Italian Ministry of Health within the framework of 2006 Finalized Research Programmes (D.Lgs.n.502/1992).
Publisher Copyright:
© 2020, Springer-Verlag GmbH Germany, part of Springer Nature.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/12
Y1 - 2020/12
N2 - Purpose: Intracranial carotid artery occlusion represents an underinvestigated cause of acute ischemic stroke as well as an indication for mechanical thrombectomy. We investigated baseline and procedural characteristics, outcomes and predictors of outcome in patients with acute ischemic stroke secondary to intracranial carotid artery occlusion. Methods: A retrospective analysis of the Italian Registry of Endovascular Treatment in Acute Stroke was performed. Patients with intracranial carotid artery occlusion (infraclinoid and supraclinoid) with or without cervical artery occlusion but with patent intracranial arteries were included. The 3‑month functional independence, mortality, successful reperfusion and symptomatic intracranial hemorrhage were evaluated. Results: Intracranial carotid artery occlusion with patent intracranial arteries was diagnosed in 387 out of 4940 (7.8%) patients. The median age was 74 years and median baseline National Institute of Health Stroke Scale (NIHSS) was 18. Functional independence was achieved in 130 (34%) patients, successful reperfusion in 289 (75%) and symptomatic intracranial hemorrhage in 33 (9%), whereas mortality occurred in 111 (29%) patients. In univariate analysis functional independence was associated with lower age, lower NIHSS at presentation, higher rate of successful reperfusion and lower rate of symptomatic intracranial hemorrhage. Multivariable regression analysis found age (odds ratio, OR:1.03; P = 0.006), NIHSS at presentation (OR: 1.07; P < 0.001), diabetes (OR: 2.60; P = 0.002), successful reperfusion (OR:0.20; P < 0.001) and symptomatic intracranial hemorrhage (OR: 4.17; P < 0.001) as the best independent predictors of outcome. Conclusion: Our study showed a not negligible rate of intracranial carotid artery occlusion with patent intracranial arteries, presenting mostly as severe stroke, with an acceptable rate of 3‑month functional independence. Age, NIHSS at presentation and successful reperfusion were the best independent predictors of outcome.
AB - Purpose: Intracranial carotid artery occlusion represents an underinvestigated cause of acute ischemic stroke as well as an indication for mechanical thrombectomy. We investigated baseline and procedural characteristics, outcomes and predictors of outcome in patients with acute ischemic stroke secondary to intracranial carotid artery occlusion. Methods: A retrospective analysis of the Italian Registry of Endovascular Treatment in Acute Stroke was performed. Patients with intracranial carotid artery occlusion (infraclinoid and supraclinoid) with or without cervical artery occlusion but with patent intracranial arteries were included. The 3‑month functional independence, mortality, successful reperfusion and symptomatic intracranial hemorrhage were evaluated. Results: Intracranial carotid artery occlusion with patent intracranial arteries was diagnosed in 387 out of 4940 (7.8%) patients. The median age was 74 years and median baseline National Institute of Health Stroke Scale (NIHSS) was 18. Functional independence was achieved in 130 (34%) patients, successful reperfusion in 289 (75%) and symptomatic intracranial hemorrhage in 33 (9%), whereas mortality occurred in 111 (29%) patients. In univariate analysis functional independence was associated with lower age, lower NIHSS at presentation, higher rate of successful reperfusion and lower rate of symptomatic intracranial hemorrhage. Multivariable regression analysis found age (odds ratio, OR:1.03; P = 0.006), NIHSS at presentation (OR: 1.07; P < 0.001), diabetes (OR: 2.60; P = 0.002), successful reperfusion (OR:0.20; P < 0.001) and symptomatic intracranial hemorrhage (OR: 4.17; P < 0.001) as the best independent predictors of outcome. Conclusion: Our study showed a not negligible rate of intracranial carotid artery occlusion with patent intracranial arteries, presenting mostly as severe stroke, with an acceptable rate of 3‑month functional independence. Age, NIHSS at presentation and successful reperfusion were the best independent predictors of outcome.
KW - Circle of Willis
KW - Endovascular treatment
KW - Large vessel occlusion
KW - Outcome
KW - Stroke severity
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U2 - 10.1007/s00062-020-00980-5
DO - 10.1007/s00062-020-00980-5
M3 - Article
AN - SCOPUS:85097535989
JO - Klinische Neuroradiologie
JF - Klinische Neuroradiologie
SN - 1869-1439
ER -