[en] [en] BACKGROUND: We evaluated the clinical and safety outcomes of emergent carotid artery stenting (eCAS) plus endovascular thrombectomy (EVT) among patients with anterior tandem lesion (TL) and large ischemic core (LIC).
METHODS: This retrospective study included consecutive stroke patients enrolled in the Endovascular Treatment in Ischemic Stroke Registry in France between January 2015 and June 2023. We compared the outcomes of carotid stenting vs no stenting in tandem lesion with pre-treatment LIC (Alberta Stroke Program Early CT Score (ASPECTS) 3-5) and stenting in tandem lesion vs thrombectomy alone for isolated intracranial occlusions with pre-treatment LIC. Primary outcome was a score of 0 to 3 on the modified Rankin scale (mRS) at 90 days. Multivariable mixed-effects logistic regression was performed.
RESULTS: Among 218 tandem patients with LIC, 55 were treated with eCAS plus EVT. The eCAS group had higher odds of 90-day mRS 0-3 (adjusted Odds Ratio (aOR) 2.40, 95% confidence interval (CI) 1.10 to 5.21; p=0.027). There were no differences in the risk of any intracerebral hemorrhage (OR 1.41, 95% CI 0.69 to 2.86; p=0.346), parenchymal hematoma (aOR 1.216, 95% CI 0.49 to 3.02; p=0.675), symptomatic intracerebral hemorrhage (aOR 1.45, 95% CI 0.60 to 3.48; p=0.409), or 90-day mortality (aOR 0.74, 95% CI 0.33 to 1.68; p=0.472). eCAS was associated with a higher rate of carotid patency at day 1 (aOR 3.54, 95% CI 1.14 to 11.01; p=0.028). Safety outcomes were similar between EVT+eCAS group in TL-LIC and EVT alone group in isolated intracranial occlusions with LIC.
CONCLUSION: eCAS appears to be a safe and effective strategy in patients with TL and LIC volume.
Disciplines :
Neurology
Author, co-author :
Deliktas, Yakub ; Diagnostic and Therapeutic Neuroradiology, CHRU Nancy, Nancy, France
Derraz, Imad ; Neuroradiology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
Finitsis, Stephanos ; Neuroradiology, Aristotle University of Thessaloniki, Ahepa Hospital, Thessaloniki, Greece
Caroff, Jildaz ; Interventional Neuroradiology - NEURI Brain Vascular Center, Hôpital Bicêtre, Le Kremlin Bicêtre, France
Bourcier, Romain; Neuroradiology, CHU Nantes, Nantes, France
Soize, Sébastien ; Neuroradiology, CHU Reims, Reims, France
Moulin, Solène; Neurology, CHU Reims, Reims, France
Richard, Sébastien ; Neurology Stroke Unit, CHRU Nancy, Nancy, France
Marnat, Gaultier ; Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
Hoferica, Matúš; Diagnostic and Therapeutic Neuroradiology, Hôpital Purpan, Toulouse, France
Cognard, Christophe ; Diagnostic and Therapeutic Neuroradiology, Hôpital Purpan, Toulouse, France
Desilles, Jean-Philippe; Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
Anadani, Mohammad; Department of Neurosciences, Intent Medical Group, NorthShore University HealthSystem, Arlington Heights, Illinois, USA
Olivot, Jean-Marc ; Neurology, Stroke Unit, Hôpital Purpan, Toulouse, France
Casolla, Barbara; Neurology, Stroke Unit, CHU Nice, Nice, France
Consoli, Arturo ; Diagnostic and Interventional Neuroradiology, Hôpital Foch, Suresnes, France
Lapergue, Bertrand; Neurology, Stroke Unit, Hôpital Foch, Suresnes, France
Gory, Benjamin; Diagnostic and Therapeutic Neuroradiology, CHRU Nancy, Nancy, France b.gory@chru-nancy.fr ; Université de Lorraine, INSERM U1254, IADI, Nancy, France
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.
Jovin TG, Nogueira RG, Lansberg MG, et al. Thrombectomy for anterior circulation stroke beyond 6 H from time last known well (AURORA): a systematic review and individual patient data meta-analysis. Lancet 2022;399:249–58.
Yoshimura S, Sakai N, Yamagami H, et al. Endovascular therapy for acute stroke with a large ischemic region. N Engl J Med 2022;386:1303–13.
Sarraj A, Hassan AE, Abraham MG, et al. Select2 investigators trial of Endovascular Thrombectomy for large ischemic strokes. N Engl J Med 2023;388:1259–71.
Huo X, Ma G, Tong X, et al. ANGEL-ASPECT investigators trial of Endovascular therapy for acute ischemic stroke with large infarct. N Engl J Med 2023;388:1272–83.
Bendszus M, Fiehler J, Subtil F, et al. TENSION investigators. Endovascular Thrombectomy for acute ischaemic stroke with established large infarct: Multicentre, open-label, randomised trial. Lancet 2023;402:1753–63.
Wilson MP, Murad MH, Krings T, et al. Management of Tandem Occlusions in acute ischemic stroke - intracranial versus Extracranial first and Extracranial Stenting versus Angioplasty alone: a systematic review and meta-analysis. J Neurointerv Surg 2018;10:721–8.
Sadeh-Gonik U, Tau N, Friehmann T, et al. Thrombectomy outcomes for acute stroke patients with anterior circulation Tandem lesions: a clinical Registry and an update of a systematic review with meta-analysis. Eur J Neurol 2018;25:693–700.
Diana F, Romoli M, Toccaceli G, et al. Emergent carotid Stenting versus no Stenting for acute ischemic stroke due to Tandem occlusion: a meta-analysis. J Neurointerv Surg 2023;15:428–32.
Anadani M, Marnat G, Consoli A, et al. Endovascular therapy of anterior circulation Tandem Occlusions: pooled analysis from the TITAN and ETIS registries. Stroke 2021;52:3097–105.
Farooqui M, Zaidat OO, Hassan AE, et al. Functional and safety outcomes of carotid artery Stenting and mechanical Thrombectomy for large vessel occlusion ischemic stroke with Tandem lesions. JAMA Netw Open 2023;6:e230736.
Feil K, Herzberg M, Dorn F, et al. Tandem lesions in anterior circulation stroke: analysis of the German stroke Registry-Endovascular treatment. Stroke 2021;52:1265–75.
Anadani M, Spiotta AM, Alawieh A, et al. TITAN (Thrombectomy in tandem lesions) investigators. emergent carotid Stenting plus Thrombectomy after Thrombolysis in tandem strokes: analysis of the TITAN Registry. Stroke 2019;50:2250–2.
Anadani M, Marnat G, Consoli A, et al. TITAN (Thrombectomy in tandem lesions) investigators; Endovascular treatment in ischemic stroke (ETIS) investigators. Endovascular therapy with or without intravenous Thrombolysis in acute stroke with Tandem occlusion. J Neurointerv Surg 2022;14:314–20.
Rodriguez-Calienes A, Galecio-Castillo M, Farooqui M, et al. Safety outcomes of mechanical Thrombectomy versus combined Thrombectomy and intravenous Thrombolysis in tandem lesions. Stroke 2023;54:2522–33.
Derraz I, Moulin S, Gory B, et al. Endovascular Thrombectomy outcomes with and without intravenous Thrombolysis for large ischemic cores identified with CT or MRI. Radiology 2023;309:e230440.
Sun J, Lam C, Christie L, et al. Risk factors of hemorrhagic transformation in acute ischaemic stroke: A systematic review and meta-analysis. Front Neurol 2023;14:1079205.
Seners P, Wouters A, Maïer B, et al. Role of brain imaging in the prediction of intracerebral hemorrhage following Endovascular therapy for acute stroke. Stroke 2023;54:2192–203.
Bricout N, Personnic T, Ferrigno M, et al. Day 1 Extracranial internal carotid artery Patency is associated with good outcome after mechanical Thrombectomy for Tandem occlusion. Stroke 2018;49:2520–2.
Zapata-Arriaza E, Medina-Rodriguez M, Ortega-Quintanilla J, et al. Relevance of carotid Reocclusion in tandem lesions. J Atheroscler Thromb 2023;30:636–48.
Zhu F, Hossu G, Soudant M, et al. Effect of emergent carotid Stenting during Endovascular therapy for acute anterior circulation stroke patients with Tandem occlusion: A multicenter, randomized, clinical trial (TITAN) protocol. Int J Stroke 2021;16:342–8.
