TY - JOUR
T1 - Mechanical Thrombectomy in Acute Ischemic Stroke with Tandem Occlusions
T2 - Impact of Extracranial Carotid Lesion Etiology on Endovascular Management and Outcome
AU - Ros, Valerio Da
AU - Scaggiante, Jacopo
AU - Pitocchi, Francesca
AU - Sallustio, Fabrizio
AU - Lattanzi, Simona
AU - Umana, Giuseppe Emmanuele
AU - Chaurasia, Bipin
AU - di Poggio, Monica Bandettini
AU - Toscano, Gianpaolo
AU - Bigliani, Claudia Rolla
AU - Ruggiero, Maria
AU - Haznedari, Nicolò
AU - Sgreccia, Alessandro
AU - Sanfilippo, Giuseppina
AU - Diomedi, Marina
AU - Finocchi, Cinzia
AU - Floris, Roberto
N1 - Publisher Copyright:
©AANS 2021, except where prohibited by US copyright law
PY - 2021/7
Y1 - 2021/7
N2 - 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 CArelated TOs.
AB - 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 CArelated TOs.
KW - acute ischemic stroke
KW - carotid atherosclerosis
KW - carotid dissection
KW - endovascular acute stroke intervention
KW - tandem occlusions
KW - thrombectomy
KW - thrombolysis
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U2 - 10.3171/2021.4.FOCUS21111
DO - 10.3171/2021.4.FOCUS21111
M3 - Article
AN - SCOPUS:85109157987
VL - 51
SP - 1
EP - 7
JO - Neurosurgical Focus
JF - Neurosurgical Focus
SN - 1092-0684
IS - 1
ER -