Endovascular treatment of patients with acute ischemic stroke and tandem occlusion due to internal carotid artery dissection: A multicenter experience-Reference-Cited by-同舟云学术

Endovascular treatment of patients with acute ischemic stroke and tandem occlusion due to internal carotid artery dissection: A multicenter experience

Published:2022-06-14 Issue:1 Volume:36 Page:86-93
ISSN:1971-4009
Container-title:The Neuroradiology Journal
language:en
Short-container-title:Neuroradiol J

Author:

Da Ros Valerio¹^ORCID,Pusceddu Federica¹^ORCID,Lattanzi Simona²,Scaggiante Jacopo³^ORCID,Sallustio Fabrizio⁴,Marrama Federico⁴,Bandettini di Poggio Monica⁵,Toscano Gianpaolo⁶,Di Giuliano Francesca¹,Rolla-Bigliani Claudia⁷,Ruggiero Maria⁸,Haznedari Niccolo⁸,Sgreccia Alessandro⁹^ORCID,Sanfilippo Giuseppina¹⁰,Finocchi Cinzia⁵,Diomedi Marina¹¹,Tomasi Santino O¹²¹³,Palmisciano Paolo¹⁴,Umana Giuseppe E¹⁴,Strigari Lidia¹⁵,Griessenauer Christoph J¹²¹⁶¹⁷^ORCID,Pitocchi Francesca¹^ORCID,Garaci Francesco¹,Floris Roberto¹

Affiliation:

1. Diagnostic Imaging Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy

2. Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Italy

3. Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA

4. Comprehensive Stroke Center, University of Rome Tor Vergata, Italy

5. Department of Neurosciences, Policlinico Hospital San Martino, University of Genova, Italy

6. Stroke Unit University Policlinico San Matteo, IRCCS Mondino Fundation, Italy

7. Department of Diagnostic and Interventional Neuroradiology, University Hospital, San Martino, Italy

8. Neuroradiology Unit, AUSL Romagna, Italy

9. Clinic of Neuroradiology and Interventional Neuroradiology, AOU Ospedali Riuniti di Ancona, Italy

10. Department of Diagnostic and Interventional Radiology and Neuroradiology, IRCCS Policlinico San Matteo, Italy

11. Department of Systemic Medicine, University of Rome Tor Vergata, Italy

12. Department of Neurological Surgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria

13. Laboratory for Microsurgical Neuroanatomy, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria

14. Department of Neurosurgery, Trauma and Gamma-Knife Center, Cannizzaro Hospital, Italy

15. Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy

16. Department of Neurosurgery, Geisinger Health System, Danville, PA, USA

17. Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria

Abstract

Background The optimal management of patients with acute ischemic stroke (AIS) due to tandem occlusion (TO) and underlying carotid dissection (CD) remains unclear. Objective We present our multicenter-experience of endovascular treatment (EVT) approach used and outcomes for AIS patients with CD-related TO (CD-TO). Methods Consecutive AIS patients underwent EVT for CD-TO at five Italian Neuro-interventional Tertiary Stroke Centers were retrospectively identified. TO from atherosclerosis and other causes of, were excluded from the final analysis. Primary outcome was successful (mTICI 2b-3) and complete reperfusion (mTICI 3); secondary outcome was patients’ 3-months functional independence (mRS≤2). Results Among 214 AIS patients with TO, 45 presented CD-TO. Median age was 54 years (range 29–86), 82.2% were male. Age <65 years ( p < 0.0001), lower baseline NIHSS score ( p = 0.0002), and complete circle of Willis ( p = 0.0422) were associated with mRS ≤ 2 at the multivariate analysis. Comparisons between antegrade and retrograde approaches resulted in differences for baseline NIHSS scores ( p = 0.001) and number of EVT attempts per-procedure ( p = 0.001). No differences in terms of recanalization rates were observed between antegrade and retrograde EVT approaches ( p = 0.811) but higher rates of mTICI3 revascularization was observed with the retrograde compared to the antegrade approach (78.6% vs 73.3%), anyway not statistically significant. CD management technique (angioplasty vs aspiration vs emergent stenting) did not correlate with 3-months mRS≤2. Conclusion AIS patients with CD-TO were mostly treated with the retrograde approach with lower number of attempts per-procedure but it offered similar recanalization rates compared with the antegrade approach. Emergent carotid artery stenting (CAS) proved to be safe for CD management but it does not influence 3-months patients’ clinical outcomes.

Publisher

SAGE Publications

Subject

Neurology (clinical),Radiology, Nuclear Medicine and imaging,General Medicine

Link

http://journals.sagepub.com/doi/pdf/10.1177/19714009221108673

Reference24 articles.

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

3. Multicentric Experience in Distal-to-Proximal Revascularization of Tandem Occlusion Stroke Related to Internal Carotid Artery Dissection

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