Cervical Dissection in Patients With Tandem Lesions Is Associated With Distal Embolism and Lower Recanalization Success-Reference-Cited by-同舟云学术

Cervical Dissection in Patients With Tandem Lesions Is Associated With Distal Embolism and Lower Recanalization Success

Published:2024-07 Issue:7 Volume:55 Page:1808-1817
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

Galecio-Castillo Milagros¹^ORCID,Guerrero Waldo R.²^ORCID,Hassan Ameer E.³^ORCID,Farooqui Mudassir¹^ORCID,Jumaa Mouhammad A.⁴^ORCID,Divani Afshin A.⁵^ORCID,Abraham Michael G.⁶^ORCID,Petersen Nils H.⁷^ORCID,Fifi Johanna T.⁸^ORCID,Malik Amer M.⁹^ORCID,Siegler James E.¹⁰¹¹^ORCID,Nguyen Thanh N.¹²^ORCID,Sheth Sunil A.¹³^ORCID,Yoo Albert J.¹⁴^ORCID,Linares Guillermo¹⁵^ORCID,Janjua Nazli¹⁶^ORCID,Quispe-Orozco Darko¹^ORCID,Olivé-Gadea Marta¹⁷^ORCID,Tekle Wondwossen G.³^ORCID,Zaidi Syed F.⁴^ORCID,Sabbagh Sara Y.⁵,Barkley Tiffany⁶^ORCID,Prasad Ayush⁷,De Leacy Reade A.⁸^ORCID,Abdalkader Mohamad¹²^ORCID,Salazar-Marioni Sergio¹³^ORCID,Soomro Jazba¹⁴^ORCID,Gordon Weston¹⁵^ORCID,Turabova Charoskhon¹⁶^ORCID,Rodriguez-Calienes Aaron¹¹⁸^ORCID,Dibas Mahmoud¹^ORCID,Mokin Maxim²^ORCID,Yavagal Dileep R.⁹^ORCID,Ribo Marc¹⁷^ORCID,Jovin Tudor G.¹⁰¹¹^ORCID,Ortega-Gutierrez Santiago¹^ORCID

Affiliation:

1. Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City (M.G.-C., M.F., D.Q.-O., A.R.-C., M.D., S.O.-G.).

2. Department of Neurology and Brain Repair, University of South Florida, Tampa (W.R.G., M.M.).

3. Department of Neurology, Valley Baptist Medical Center/University of Texas Rio Grande Valley, Harlingen (A.E.H., W.G.T.).

4. Department of Neurology, ProMedica Toledo Hospital, OH (M.A.J., S.F.Z.).

5. Department of Neurology, University of New Mexico Health Science Center, Albuquerque (A.A.D., S.Y.S.).

6. Department of Neurology, University of Kansas Medical Center (M. Abraham, T.B.).

7. Department of Neurology, Yale University School of Medicine, New Haven, CT (N.H.P., A.P.).

8. Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.F., R.D.L.).

9. Department of Neurology, University of Miami Miller School of Medicine, FL (A.M.M., D.R.Y.).

10. Cooper Neurological Institute, Cooper University Hospital, Camden, NJ (J.E.S., T.G.J.).

11. Cooper Medical School of Rowan University, Candem, NJ (J.E.S., T.G.J.).

12. Department of Neurology, Boston Medical Center, MA (T.N.N., M. Abdalkader).

13. Department of Neurology, UT Health McGovern Medical School, Houston, TX (S.S., S.S.-M.).

14. Texas Stroke Institute, Dallas-Fort Worth (A.J.Y., J.S.).

15. Department of Neurology, Saint Louis University, St. Louis, MO (G.L., W.G.).

16. Asia Pacific Comprehensive Stroke Institute, Pomona Valley Hospital Medical Center, CA (N.J., C.T.).

17. Department of Neurology, Hospital Vall d’Hebron, Barcelona, Spain (M.O.-G., M.R.).

18. Neuroscience, Clinical Effectiveness and Public Health Research Group, Universidad Científica del Sur, Lima, Peru (A.R.-C.).

Abstract

BACKGROUND: Tandem lesions consist of cervical internal carotid artery (ICA) stenosis or occlusion, most commonly of atherosclerosis or dissection etiology, plus a large vessel occlusion. In this study, we compare outcomes in patients with atherosclerosis versus dissection of the cervical ICA. METHODS: This multicenter retrospective cohort study includes data from tandem lesion patients who underwent endovascular treatment from 2015 to 2020. Atherosclerosis was defined as ICA stenosis/occlusion associated with a calcified lesion and dissection by the presence of a tapered or flame-shaped lesion and intramural hematoma. Primary outcome: 90-day functional independence (modified Rankin Scale score, 0–2); secondary outcomes: 90-day favorable shift in the modified Rankin Scale score, modified Thrombolysis in Cerebral Infarction score 2b-3, modified Thrombolysis in Cerebral Infarction score 2c-3, symptomatic intracranial hemorrhage, parenchymal hematoma type 2, petechial hemorrhage, distal embolization, early neurological improvement, and mortality. Analysis was performed with matching by inverse probability of treatment weighting. RESULTS: We included 526 patients (68 [59–76] years; 31% females); 11.2% presented dissection and 88.8%, atherosclerosis. Patients with dissection were younger, had lower rates of hypertension, hyperlipidemia, diabetes, and smoking history. They also exhibited higher rates of ICA occlusion, multiple stents (>1), and lower rates of carotid self-expanding stents. After matching and adjusting for covariates, there were no differences in 90-day functional independence. The rate of successful recanalization was significantly lower in the dissection group (adjusted odds ratio, 0.38 [95% CI, 0.16–0.91]; P =0.031), which also had significantly higher rates of distal emboli (adjusted odds ratio, 2.53 [95% CI, 1.15–5.55]; P =0.021). There were no differences in other outcomes. Acute ICA stenting seemed to increase the effect of atherosclerosis in successful recanalization. CONCLUSIONS: This study reveals that among patients with acute stroke with tandem lesions, cervical ICA dissection is associated with higher rates of distal embolism and lower rates of successful recanalization than atherosclerotic lesions. Using techniques to minimize the risk of distal embolism may mitigate this contrast. Further prospective randomized trials are warranted to fully understand these associations.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Reference33 articles.

1. Emergent Management of Tandem Lesions in Acute Ischemic Stroke

2. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials

3. Acute ischemic stroke with tandem lesions: technical endovascular management and clinical outcomes from the ESCAPE trial

4. Tandem Internal Carotid Artery/Middle Cerebral Artery Occlusion

5. Functional and Safety Outcomes of Carotid Artery Stenting and Mechanical Thrombectomy for Large Vessel Occlusion Ischemic Stroke With Tandem Lesions