[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
scite shows how a scientific paper has been cited by providing the context of the citation, a classification describing whether it supports, mentions, or contrasts the cited claim, and a label indicating in which section the citation was made.
Bibliography
Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2019;50:e344-418.
Hassan AE, Chaudhry SA, Miley JT, et al. Microcatheter to recanalization (procedure time) predicts outcomes in endovascular treatment in patients with acute ischemic stroke: when do we stop? AJNR Am J Neuroradiol 2013;34:354-9.
Saver JL, Goyal M, van der Lugt A, et al. Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis. JAMA 2016;316:1279-88.
Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016;387:1723-31.
Lapergue B, Blanc R, Gory B, et al. Effect of endovascular contact aspiration vs stent retriever on revascularization in patients with acute ischemic stroke and large vessel occlusion: the ASTER randomized clinical trial. JAMA 2017;318:443-52.
Kaesmacher J, Gralla J, Mosimann PJ, et al. Reasons for reperfusion failures in stent-retriever-based thrombectomy: registry analysis and proposal of a classification system. AJNR Am J Neuroradiol 2018;39:1848-53.
Dumont TM, Bina RW. Difficult vascular access anatomy associated with decreased success of revascularization in emergent thrombectomy. J Vasc Interv Neurol 2018;10:11-14.
Ribo M, Flores A, Rubiera M, et al. Difficult catheter access to the occluded vessel during endovascular treatment of acute ischemic stroke is associated with worse clinical outcome. J Neurointerv Surg 2013;5 Suppl 1:i70-3.
Kaymaz ZO, Nikoubashman O, Brockmann MA, et al. Influence of carotid tortuosity on internal carotid artery access time in the treatment of acute ischemic stroke. Interv Neuroradiol 2017;23:583-8.
Barral M, Lassalle L, Dargazanli C, et al. Predictors of favorable outcome after mechanical thrombectomy for anterior circulation acute ischemic stroke in octogenarians. J Neuroradiol 2018;45:211-6.
Drouard-de Rousiers E, Lucas L, Richard S, et al. Impact of reperfusion for nonagenarians treated by mechanical thrombectomy: insights from the ETIS registry. Stroke 2019;50:3164-9.
Chen SH, Snelling BM, Sur S, et al. Transradial versus transfemoral access for anterior circulation mechanical thrombectomy: comparison of technical and clinical outcomes. J Neurointerv Surg 2019;11:874-8.
Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 2009;62:1006-12.
Benichi S, Consoli A, Coskun O, et al. Thrombectomy by direct cervical access in a case of common carotid occlusion with collateral supply to the internal carotid artery: an uncommon anatomical variant. World Neurosurg 2019. doi:10.1016/j. wneu.2018.12.133. [Epub ahead of print: 03 Jan 2019].
Castaño C, Remollo S, Garciá MR, et al. Mechanical thrombectomy with 'ADAPT' technique by transcervical access in acute ischemic stroke. Neuroradiol J 2015;28:617-22.
Cilingiroglu M, Hakeem A, Wholey M, et al. Direct carotid access for endovascular management of acute ischaemic stroke. EuroIntervention 2017;13:e1120-1.
Cohen JE, Gomori JM, Leker RR, et al. A reappraisal of the common carotid artery as an access site in interventional procedures for acute stroke therapies. J Clin Neurosci 2012;19:323-6.
Fjetland L, Roy S. Transcarotid endovascular thrombectomy for acute ischemic stroke. J Vasc Interv Radiol 2018;29:1006-10.
Jadhav AP, Ribo M, Grandhi R, et al. Transcervical access in acute ischemic stroke. J Neurointerv Surg 2014;6:652-7.
Kawabori M, Osanai T, Goto S, et al. Direct common carotid artery puncture for acute thrombectomy against ischemic stroke. J Neurosurg Sci 2018;62:612-4.
Roche A, Griffin E, Looby S, et al. Direct carotid puncture for endovascular thrombectomy in acute ischemic stroke. J Neurointerv Surg 2019;11:647-52.
Roche AD, Murphy B, Adams N, et al. Direct common carotid artery puncture for endovascular treatment of acute large vessel ischemic stroke in a patient with aortic coarctation. J Stroke Cerebrovasc Dis 2017;26:e211-3.
Styczen H, Behme D, Hesse AC, et al. Alternative transcarotid approach for endovascular treatment of acute ischemic stroke patients: a case series. Neurointervention 2019;14:131-6.
Yuan Z, Li J, Zhou M, et al. Common carotid artery puncture in anterior circulation thrombectomy in patients with unfavorable vascular anatomy: a case-control study. Medicine 2019;98:e17477.
Sussman ES, Martin B, Mlynash M, et al. Thrombectomy for acute ischemic stroke in nonagenarians compared with octogenarians. J Neurointerv Surg 2020;12:266-70.
Joshi KC, Beer-Furlan A, Crowley RW, et al. Transradial approach for neurointerventions: a systematic review of the literature. J Neurointerv Surg 2020;12:886-92.
Stone JG, Zussman BM, Tonetti DA, et al. Transradial versus transfemoral approaches for diagnostic cerebral angiography: a prospective, single-center, non-inferiority comparative effectiveness study. J Neurointerv Surg 2020;12:993-8.
Guenego A, Khoury N, Blanc R, et al. Gadolinium-enhanced extracranial MRA prior to mechanical thrombectomy is not associated with an improved procedure speed. Front Neurol 2018;9:1171.
Blanc R, Mounayer C, Piotin M, et al. Hemostatic closure device after carotid puncture for stent and coil placement in an intracranial aneurysm: technical note. AJNR Am J Neuroradiol 2002;23:978-81.
Schönenberger S, Hendén PL, Simonsen CZ, et al. Association of general anesthesia vs procedural sedation with functional outcome among patients with acute ischemic stroke undergoing thrombectomy: a systematic review and meta-analysis. JAMA 2019;322:1283-93.
Bechara CF, Annambhotla S, Lin PH. Access site management with vascular closure devices for percutaneous transarterial procedures. J Vasc Surg 2010;52:1682-96.
Patel MR, Jneid H, Derdeyn CP, et al. Arteriotomy closure devices for cardiovascular procedures: a scientific statement from the American Heart Association. Circulation 2010;122:1882-93.
Wiesmann M, Kalder J, Reich A, et al. Feasibility of combined surgical and endovascular carotid access for interventional treatment of ischemic stroke. J Neurointerv Surg 2016;8:571-5.
Wiesmann M, Kalder J, Reich A, et al. Combined surgical and endovascular carotid access for endovascular thrombectomy in acute ischemic stroke. World Neurosurg 2019;132:e1-4.
This website uses cookies to improve user experience. Read more
Save & Close
Accept all
Decline all
Show detailsHide details
Cookie declaration
About cookies
Strictly necessary
Performance
Strictly necessary cookies allow core website functionality such as user login and account management. The website cannot be used properly without strictly necessary cookies.
This cookie is used by Cookie-Script.com service to remember visitor cookie consent preferences. It is necessary for Cookie-Script.com cookie banner to work properly.
Performance cookies are used to see how visitors use the website, eg. analytics cookies. Those cookies cannot be used to directly identify a certain visitor.
Used to store the attribution information, the referrer initially used to visit the website
Cookies are small text files that are placed on your computer by websites that you visit. Websites use cookies to help users navigate efficiently and perform certain functions. Cookies that are required for the website to operate properly are allowed to be set without your permission. All other cookies need to be approved before they can be set in the browser.
You can change your consent to cookie usage at any time on our Privacy Policy page.
