[en] [en] BACKGROUND: Endovascular therapy (EVT) for acute ischemic stroke (AIS) can be challenging in older patients with supra-aortic tortuosity. Rescue carotid puncture (RCP) can be an alternative in case of supra-aortic catheterization failure by femoral access, but data regarding RCP are scarce. We sought to investigate the feasibility, effectiveness and safety of RCP for AIS treated by EVT.
METHODS: Patients treated by EVT with RCP were included from January 2012 to December 2019 in the Endovascular Treatment in Ischemic Stroke (ETIS) multicentric registry. Main outcomes included reperfusion rates ( ≥ TICI2B), 3 month functional outcome (modified Rankin Scale) and 3 month mortality. We also performed an additional systematic review of the literature according to the PRISMA checklist to summarize previous studies on RCP.
RESULTS: 25 patients treated by EVT with RCP were included from the ETIS registry. RCP mainly concerned elderly patients (median age 85 years, range 73-92) with supra-aortic tortuosity (n=16 (64%)). Intravenous thrombolysis (IVT) was used for nine patients (36%). Successful reperfusion was achieved in 64%, 87.5% of patients were dependent at 3 months, and 3 month mortality was 45.8%. The systematic review yielded comparable results. In pooled individual data, there was a shift toward better functional outcome in patients with successful reperfusion (median (IQR) 4 (2-6) vs 6 (4-6), p=0.011).
CONCLUSION: RCP mainly concerned elderly patients admitted for AIS with anterior LVO with supra-aortic tortuosity. The procedure seemed feasible, notably for patients treated with IVT, and led to significant reperfusion rates at the end of procedure, but with pronounced unfavorable outcomes at 3 months. RCP should be performed under general anesthesia to avoid life-threatening complications and ensure airways safety. Finally, RCP led to low rates of closure complications, emphasizing that this concern should not withhold RCP, if indicated.
Disciplines :
Neurology
Author, co-author :
Allard, Julien; Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
Ghazanfari, Sam; Stroke Center, Hôpital Foch, Suresnes, Île-de-France, France
Mahmoudi, Mehdi; Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
Labreuche, Julien; ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille University Hospital Center, Lille, Hauts-de-France, France
Escalard, Simon; Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
Delvoye, François ; Université de Liège - ULiège > Département des sciences cliniques ; Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
Ciccio, Gabriele; Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
Smajda, Stanislas; Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
Redjem, Hocine; Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
Hebert, Solène; Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
Consoli, Arturo; Neuroradiology, Hopital Foch, Suresnes, Île-de-France, France
Costalat, Vincent; Department of Neuroradiology, University Hospital Centre Montpellier, Montpellier, Occitanie, France
Desilles, Jean-Philippe; Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France ; Université de Paris, Paris, France ; Laboratory of Vascular Translational Science, U1148, Paris, France
Mazighi, Mikael; Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France ; Université de Paris, Paris, France ; Laboratory of Vascular Translational Science, U1148, Paris, France
Piotin, Michel; Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France ; Laboratory of Vascular Translational Science, U1148, Paris, France
Dargazanli, Cyril; Department of Neuroradiology, University Hospital Centre Montpellier, Montpellier, Occitanie, France
Lapergue, Bertrand; Stroke Center, Hôpital Foch, Suresnes, Île-de-France, France
Blanc, Raphaël ; Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France rblanc@for.paris
Maïer, Benjamin; Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France ; Université de Paris, Paris, France ; Laboratory of Vascular Translational Science, U1148, Paris, France
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