[en] [en] BACKGROUND: The best treatment for acute ischemic stroke (AIS) due to isolated cervical internal carotid artery occlusion (CICAO) (i.e., without associated occlusion of the circle of Willis) is still unknown. In this study, we aimed to describe EVT safety and clinical outcome in patients with CICAO.
METHODS: We analyzed data of all consecutive patients, included in the Endovascular Treatment in Ischemic Stroke (ETIS) Registry between 2013 and 2020, who presented AIS and proven CICAO on angiogram and underwent EVT. We assessed carotid recanalization, procedural complications, National Institutes of Health Stroke Scale (NIHSS) at 24 h post-EVT, and 3-month favorable outcome (modified Rankin Scale, mRS ≤ 2 or equal to the pre-stroke value).
RESULTS: Forty-five patients were included (median age: 70 years; range: 62-82 years). The median NIHSS before EVT was 14 (9-21). Carotid stenting was performed in 23 (51%) patients. Carotid recanalization at procedure end and on control imaging was observed in 37 (82%) and 29 (70%) patients, respectively. At day 1 post-EVT, the NIHSS remained stable or decreased in 25 (60%) patients; 12 (29%) patients had early neurologic deterioration (NIHSS ≥ 4 points). The rate of procedural complications was 36%, including stent thrombosis (n = 7), intracranial embolism (n = 7), and symptomatic intracranial hemorrhage (n = 1). At 3 months, 18 (40%) patients had a favorable outcome, and 10 (22%) were dead.
CONCLUSION: Our study suggests that EVT in AIS patients with moderate/severe initial deficit due to CICAO led to high rate of recanalization at day 1, and a 40% rate of favorable outcome at 3 months. There was a high rate of procedural complication which is of concern. Randomized controlled trials assessing the superiority of EVT in patients with CICAO and severe deficits are needed.
Disciplines :
Neurology
Author, co-author :
Ter Schiphorst, Adrien; Department of Neurology, CHRU Gui de Chauliac, University Hospital of Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, France
Peres, Roxane; Department of Neurology, Fondation Rothschild Hospital, Paris, France
Dargazanli, Cyril; Department of Interventional Neuroradiology, CHRU Gui de Chauliac, University Hospital of Montpellier, Montpellier, France
Blanc, Raphaël; Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
Gory, Benjamin; Department of Diagnostic and Therapeutic Neuroradiology, INSERM U1254, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France
Richard, Sébastien; Department of Neurology, Stroke Unit, INSERM U1116, 54000, Nancy, France
Marnat, Gaultier; Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
Sibon, Igor; Department of Neurology, Stroke Center, University Hospital of Bordeaux, Bordeaux, France
Guillon, Benoit; Department of Neurology, University Hospital of Nantes, Nantes, France
Bourcier, Romain; Department of Neuroradiology, University Hospital of Nantes, Nantes, France
Denier, Christian; Department of Neurology, CHU Bicêtre, Le Kremlin Bicêtre, France
Spelle, Laurent; Department of Interventional Neuroradiology, CHU Bicêtre, Le Kremlin Bicêtre, France
Labreuche, Julien; ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Université de Lille, CHU Lille, 59000, Lille, France
Consoli, Arturo; Department of Neuroradiology, Foch Hospital, Suresnes, France
Lapergue, Bertrand; Department of Neurology, Foch Hospital, Suresnes, France
Costalat, Vincent; Department of Interventional Neuroradiology, CHRU Gui de Chauliac, University Hospital of Montpellier, Montpellier, France
Obadia, Michael; Department of Neurology, Fondation Rothschild Hospital, Paris, France
Arquizan, Caroline ; Department of Neurology, CHRU Gui de Chauliac, University Hospital of Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, France. c-arquizan@chu-montpellier.fr
We would like to thank Jessica Hattinguais and Amel Benali for their help in data collection. On behalf of the ETIS-Research Investigators: CHRU Montpellier: Cyril Dargazanli, Caroline Arquizan, Vincent Costalat, Grégory Gascou, Pierre-Henri Lefèvre, Imad Derraz, Carlos Riquelme, Nicolas Gaillard, Isabelle Mourand, Lucas Corti, Federico Cagnazzo, Adrien ter Schiphorst; Hôpital Foch: Adrien Wang, Serge Evrard, Maya.Tchikviladze, Nadia Ajili, Bertrand Lapergue, David Weisenburger-Lile, Lucas Gorza, Géraldine Buard, Oguzhan Coskun, Arturo Consoli, Federico Di Maria, Georges Rodesh, Sergio Zimatore, Morgan Leguen, Julie Gratieux, Fernando Pico, Haja Rakotoharinandrasana, Philippe Tassan, Roxanna Poll, Sylvie Marinier; CHRU-Nancy: Benjamin Gory, Serge Bracard, René Anxionnat, Marc Braun, Anne-Laure Derelle, Romain Tonnelet, Liang Liao, François Zhu, Emmanuelle Schmitt, Sophie Planel, Sébastien Richard, Lisa Humbertjean, Gioia Mione, Jean-Christophe Lacour, Nolwenn Riou-Comte, Gérard Audibert, Marcela Voicu, Lionel Alb, Marie Reitter, Madalina Brezeanu, Agnès Masson, Adriana Tabarna, Iona Podar; CHRU Bordeaux: Gaultier Marnat, Florent Gariel, Xavier Barreau, Jérôme Berge, Louis Veunac, Patrice Menegon, Igor Sibon, Ludovic Lucas, Stéphane Olindo, Pauline Renou, Sharmila Sagnier, Mathilde Poli, Sabrina Debruxelles, François Rouanet, Thomas Tourdias, Jean-Sebastien Liegey, Pierre Briau, Nicolas Pangon; CHRU Nantes: Romain Bourcier, Lili Detraz, Benjamin Daumas-Duport, Pierre-Louis Alexandre, Monica Roy, Cédric Lenoble, Hubert Desal, Benoît Guillon, Solène de Gaalon, Cécile Preterre; Fondation Rothschild: Michel Piotin, Raphaël Blanc, Hocine Redjem, Simon Escalard, Jean-Philippe Desilles, François Delvoye, Stanislas Smajda, Benjamin Maier, Solène Hebert, Mikaël Mazighi, Mikael Obadia, Candice Sabben, Pierre Seners, Igor Raynouard, Ovide Corabianu, Thomas de Broucker, Eric Manchon, Guillaume Taylor, Malek Ben Maacha, Thion Laurie-Anne, Lecler Augustin, Savatovsjy Julien; Hôpital Kremlin-Bicêtre: Laurent Spelle, Christian Denier, Olivier Chassin, Vanessa Chalumeau, Jildaz Caroff, Olivier Chassin, Laura Venditti
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