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Neurosurgery. 2019 Mar 8. pii: nyz026. doi: 10.1093/neuros/nyz026. [Epub ahead of print]

Carotid Artery Stenting and Intracranial Thrombectomy for Tandem Cervical and Intracranial Artery Occlusions.

Author information

1
Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
2
Department of Radiology, Severance Hospital Stroke Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
3
Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
4
Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
5
Department of Neurology, Severance Hospital Stroke Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
6
Department of Neurology, Keimyung University Dongsan Medical center, Daegu, Republic of Korea.
7
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
8
Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
9
Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
10
Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
11
Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea.
12
Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.
13
Department of Radiology, Hanyang University Hospital, Seoul, Republic of Korea.
14
Department of Radiology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea.
15
Department of Radiology, Kyung Hee University Gangdong Hospital, Seoul, Republic of Korea.
16
Department of Radiology, St. Vincent's Hospital, Catholic University School of Medicine, Suwon, Republic of Korea.
17
Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Kore.
18
Department of Radiology, Inje University Ilsan Paik Hospital, Ilsan, Republic of Korea.
19
Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea.
20
Department of Radiology, Korea University Guro Hospital, Seoul, Republic of Korea.
21
Department of Neurology, Chonbuk National University Medical School and Hospital, Jeonju, Republic of Korea.

Abstract

BACKGROUND:

It remains controversial whether carotid artery stenting (CAS) is needed in cases of tandem cervical internal carotid artery occlusion (cICAO) and intracranial large vessel occlusion (LVO).

OBJECTIVE:

To investigate the efficacy and safety of CAS in combination with endovascular thrombectomy (CAS-EVT) in cICAO-LVO patients and to compare its outcomes with those of EVT without CAS (EVT-alone).

METHODS:

We identified all patients who underwent EVT for tandem cICAO-LVO from the prospectively maintained registries of 17 stroke centers. Patients were classified into 2 groups: CAS-EVT and EVT-alone. Clinical characteristics and procedural and clinical outcomes were compared between 2 groups. We tested whether CAS-EVT strategy was independently associated with recanalization success.

RESULTS:

Of the 955 patients who underwent EVT, 75 patients (7.9%) had cICAO-LVO. Fifty-six patients underwent CAS-EVT (74.6%), and the remaining 19 patients underwent EVT-alone (25.4%). The recanalization (94.6% vs 63.2%, P = .002) and good outcome rates (64.3% vs 26.3%, P = .007) were significantly higher in the CAS-EVT than in the EVT-alone. Mortality was significantly lower in the CAS-EVT (7.1% vs 21.6%, P = .014). There was no significant difference in the rate of symptomatic intracranial hemorrhage between 2 groups (10.7 vs 15.8%; P = .684) and according to the use of glycoprotein IIb/IIIa inhibitor (10.0% vs 12.3%; P = .999) or antiplatelet medications (10.2% vs 18.8%; P = .392). CAS-EVT strategy remained independently associated with recanalization success (odds ratio: 24.844; 95% confidence interval: 1.445-427.187).

CONCLUSION:

CAS-EVT strategy seemed to be effective and safe in cases of tandem cICAO-LVO. CAS-EVT strategy was associated with recanalization success, resulting in better clinical outcome.

KEYWORDS:

Acute stroke; Carotid arteries; Stent; Thrombectomy

PMID:
30848283
DOI:
10.1093/neuros/nyz026

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