D Behme1, A Mpotsaris2, P Zeyen2, M N Psychogios3, A Kowoll4, C J Maurer5, F Joachimski6, J Liman7, K Wasser7, C Kabbasch2, A Berlis5, M Knauth3, T Liebig2, W Weber4. 1. From the Departments of Neuroradiology (D.B., M.N.P., M.K.) daniel.behme@med.uni-goettingen.de. 2. Department of Radiology and Neuroradiology (A.M., P.Z., C.K., T.L.), University Cologne, University Hospital Cologne, Cologne, Germany. 3. From the Departments of Neuroradiology (D.B., M.N.P., M.K.). 4. Department of Radiology and Neuroradiology (A.K., W.W.), Ruhr-University-Bochum, University Medical Center Langendreer, Bochum, Germany. 5. Departments of Radiology and Neuroradiology (C.J.M., A.B.). 6. Neurology (F.J.), Klinikum Augsburg, Augsburg, Germany. 7. Neurology (J.L., K.W.), Georg-August-University Göttingen, University Medical Center, Göttingen, Germany.
Abstract
BACKGROUND AND PURPOSE: Several small case series reported a favorable clinical outcome for emergency stent placement in the extracranial internal carotid artery combined with mechanical thrombectomy in acute stroke. The rate of postinterventional symptomatic intracranial hemorrhages was reported to be as high as 20%. Therefore, we investigated the safety and efficacy of this technique in a large multicentric cohort. MATERIALS AND METHODS: The data bases of 4 German stroke centers were screened for all patients who received emergency stent placement of the extracranial internal carotid artery in combination with mechanical thrombectomy of the anterior circulation between 2007 and 2014. The primary outcome measure was the rate of symptomatic intracranial hemorrhage according to the European Cooperative Acute Stroke Study III criteria; secondary outcome measures included the angiographic revascularization results and clinical outcome. RESULTS: One hundred seventy patients with a median age of 64 years (range, 25-88 years) were treated. They presented after a median of 98 minutes (range, 52-160 minutes) with a median NIHSS score of 15 (range, 12-19). Symptomatic intracranial hemorrhages occurred in 15/170 (9%) patients; there was no statistically significant difference among groups pertaining to age, sex, intravenous rtPA, procedural timings, and the rate of successful recanalization. In 130/170 (77%) patients, a TICI score of ≥ 2b could be achieved. The in-hospital mortality rate was 19%, and 36% of patients had a favorable outcome at follow-up. CONCLUSIONS: Emergency stent placement in the extracranial internal carotid artery in combination with anterior circulation thrombectomy is effective and safe. It is not associated with a significantly higher risk of symptomatic intracranial hemorrhage compared with published series for mechanical thrombectomy alone.
BACKGROUND AND PURPOSE: Several small case series reported a favorable clinical outcome for emergency stent placement in the extracranial internal carotid artery combined with mechanical thrombectomy in acute stroke. The rate of postinterventional symptomatic intracranial hemorrhages was reported to be as high as 20%. Therefore, we investigated the safety and efficacy of this technique in a large multicentric cohort. MATERIALS AND METHODS: The data bases of 4 German stroke centers were screened for all patients who received emergency stent placement of the extracranial internal carotid artery in combination with mechanical thrombectomy of the anterior circulation between 2007 and 2014. The primary outcome measure was the rate of symptomatic intracranial hemorrhage according to the European Cooperative Acute Stroke Study III criteria; secondary outcome measures included the angiographic revascularization results and clinical outcome. RESULTS: One hundred seventy patients with a median age of 64 years (range, 25-88 years) were treated. They presented after a median of 98 minutes (range, 52-160 minutes) with a median NIHSS score of 15 (range, 12-19). Symptomatic intracranial hemorrhages occurred in 15/170 (9%) patients; there was no statistically significant difference among groups pertaining to age, sex, intravenous rtPA, procedural timings, and the rate of successful recanalization. In 130/170 (77%) patients, a TICI score of ≥ 2b could be achieved. The in-hospital mortality rate was 19%, and 36% of patients had a favorable outcome at follow-up. CONCLUSIONS: Emergency stent placement in the extracranial internal carotid artery in combination with anterior circulation thrombectomy is effective and safe. It is not associated with a significantly higher risk of symptomatic intracranial hemorrhage compared with published series for mechanical thrombectomy alone.
Authors: Manon Kappelhof; Henk A Marquering; Olvert A Berkhemer; Charles B L M Majoie Journal: J Neurointerv Surg Date: 2014-01-02 Impact factor: 5.836
Authors: A J Grau; C Weimar; F Buggle; A Heinrich; M Goertler; S Neumaier; J Glahn; T Brandt; W Hacke; H C Diener Journal: Stroke Date: 2001-11 Impact factor: 7.914
Authors: Raul G Nogueira; Helmi L Lutsep; Rishi Gupta; Tudor G Jovin; Gregory W Albers; Gary A Walker; David S Liebeskind; Wade S Smith Journal: Lancet Date: 2012-08-26 Impact factor: 79.321
Authors: Ajit S Puri; Anna L Kühn; Hyon-Jo Kwon; Muhib Khan; Samuel Y Hou; Eugene Lin; Juyu Chueh; Imramsjah M J van der Bom; Guilherme Dabus; Italo Linfante; Matthew J Gounis; Ajay K Wakhloo Journal: J Neurointerv Surg Date: 2014-02-27 Impact factor: 5.836
Authors: U Fischer; M-L Mono; G Schroth; S Jung; P Mordasini; M El-Koussy; A Weck; C Brekenfeld; O Findling; A Galimanis; M R Heldner; M Arnold; H P Mattle; J Gralla Journal: Eur J Neurol Date: 2013-02-09 Impact factor: 6.089
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: M Kappelhof; H A Marquering; O A Berkhemer; J Borst; A van der Lugt; W H van Zwam; J A Vos; G Lycklama À Nijeholt; C B L M Majoie; B J Emmer Journal: AJNR Am J Neuroradiol Date: 2018-04-05 Impact factor: 3.825
Authors: Jens Fiehler; Christophe Cognard; Mauro Gallitelli; Olav Jansen; Adam Kobayashi; Heinrich P Mattle; Keith W Muir; Mikael Mazighi; Karl Schaller; Peter D Schellinger Journal: Eur Stroke J Date: 2016-07-26
Authors: Samuel Pearce; Julian T Maingard; Hong Kuan Kok; Christen D Barras; Jeremy H Russell; Joshua A Hirsch; Ronil V Chandra; Ash Jhamb; Vincent Thijs; Mark Brooks; Hamed Asadi Journal: Clin Neuroradiol Date: 2021-03-01 Impact factor: 3.649
Authors: Wiebke Kurre; Kai Bansemir; Marta Aguilar Pérez; Rosa Martinez Moreno; Elisabeth Schmid; Hansjörg Bäzner; Hans Henkes Journal: Neuroradiology Date: 2016-10-29 Impact factor: 2.804