Donald V Heck1, Morry D Brown1. 1. Triad Radiology Associates, Novant Health Forsyth Medical Center, Winston-Salem, North Carolina, USA.
Abstract
BACKGROUND: Acute stroke from tandem extracranial carotid artery and intracranial large vessel occlusion poses challenges for emergency endovascular treatment. Establishing and maintaining patency of the carotid artery and avoiding intracranial hemorrhage are competing concerns. METHODS: Twenty-three consecutive cases of emergency carotid stenting followed by mechanical thrombectomy identified by retrospective review of the endovascular ischemic stroke database maintained prospectively at our institution since January 2011 form the basis for this report. No cases were lost to follow-up. RESULTS: Patients were selected with CT angiography or MR angiography and diffusion weighted imaging. Carotid stenting was successful in all cases, and establishment of Thrombolysis in Cerebral Ischemia 2A, 2B or 3 flow was successful in 21/23 (91%). 12/23 (52%) patients achieved a modified Rankin Scale score of 0-2 at 90 days. Symptomatic intracranial hemorrhage (SICH) occurred in 5/23 patients (22%). Of 13 patients receiving an intravenous loading dose of abciximab during the procedure, 4/13 had SICH (31%) compared with 1/10 (10%) of those who did not. Of seven patients who received intravenous tissue plasminogen activator prior to the procedure, none had SICH. 90-day mortality was 9/23 (39%). All patients who had SICH were above the median age. CONCLUSIONS: Primary stenting of the extracranial carotid artery combined with intracranial mechanical thrombectomy can be an effective treatment for tandem occlusions, can be performed with a high rate of technical success, and can achieve good clinical outcomes in selected patients. However, the incidence of SICH may be higher than in other patient populations and may be associated with the use of abciximab and advanced patient age. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
BACKGROUND:Acute stroke from tandem extracranial carotid artery and intracranial large vessel occlusion poses challenges for emergency endovascular treatment. Establishing and maintaining patency of the carotid artery and avoiding intracranial hemorrhage are competing concerns. METHODS: Twenty-three consecutive cases of emergency carotid stenting followed by mechanical thrombectomy identified by retrospective review of the endovascular ischemic stroke database maintained prospectively at our institution since January 2011 form the basis for this report. No cases were lost to follow-up. RESULTS:Patients were selected with CT angiography or MR angiography and diffusion weighted imaging. Carotid stenting was successful in all cases, and establishment of Thrombolysis in Cerebral Ischemia 2A, 2B or 3 flow was successful in 21/23 (91%). 12/23 (52%) patients achieved a modified Rankin Scale score of 0-2 at 90 days. Symptomatic intracranial hemorrhage (SICH) occurred in 5/23 patients (22%). Of 13 patients receiving an intravenous loading dose of abciximab during the procedure, 4/13 had SICH (31%) compared with 1/10 (10%) of those who did not. Of seven patients who received intravenous tissue plasminogen activator prior to the procedure, none had SICH. 90-day mortality was 9/23 (39%). All patients who had SICH were above the median age. CONCLUSIONS: Primary stenting of the extracranial carotid artery combined with intracranial mechanical thrombectomy can be an effective treatment for tandem occlusions, can be performed with a high rate of technical success, and can achieve good clinical outcomes in selected patients. However, the incidence of SICH may be higher than in other patient populations and may be associated with the use of abciximab and advanced patient age. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Authors: Philipp Gruber; Martin Hlavica; Jatta Berberat; Benjamin Victor Ineichen; Michael Diepers; Krassen Nedeltchev; Timo Kahles; Luca Remonda Journal: Interv Neuroradiol Date: 2018-11-04 Impact factor: 1.610
Authors: D Behme; A Mpotsaris; P Zeyen; M N Psychogios; A Kowoll; C J Maurer; F Joachimski; J Liman; K Wasser; C Kabbasch; A Berlis; M Knauth; T Liebig; W Weber Journal: AJNR Am J Neuroradiol Date: 2015-08-20 Impact factor: 3.825
Authors: Hesham Masoud; Thanh N Nguyen; Coleman O Martin; William E Holloway; Sudheer Ambekar; Dileep R Yavagal; Diogo C Haussen; Raul Nogueira; Diego J Lozano; Ajit Puri; Ayman Quateen; Daniela Iancu; Michael G Abraham; Michael Chen; Sonal Mehta; Tim Malisch; Franklin Marden; Robin Novakovic; Daniel Roy; Alain Weill; Alexander M Norbash Journal: Interv Neurol Date: 2015-11-20
Authors: Sung E Park; Dae S Choi; Hye J Baek; Kyeong H Ryu; Ji Y Ha; Ho C Choi; Sangmin Lee; Jungho Won; Seunguk Jung Journal: Interv Neuroradiol Date: 2020-01-28 Impact factor: 1.610