G Marnat1, M Bühlmann2, O F Eker3, J Gralla2, P Machi2,3, U Fischer2, C Riquelme3, M Arnold2, A Bonafé3, S Jung2, V Costalat3, P Mordasini4. 1. From the Interventional and Diagnostic Neuroradiology Department (G.M.), Bordeaux University Hospital, Bordeaux, France gaultier.marnat@chu-bordeaux.fr gaultier_marnat@yahoo.fr. 2. University Institute of Diagnostic and Interventional Neuroradiology (J.G., P.M.). 3. Interventional and Diagnostic Neuroradiology Department (O.F.E., P.M., C.R., A.B., V.C.), Montpellier University Hospital, Montpellier, France. 4. From the Interventional and Diagnostic Neuroradiology Department (G.M.), Bordeaux University Hospital, Bordeaux, France.
Abstract
BACKGROUND AND PURPOSE: Internal carotid dissection is a frequent cause of ischemic stroke in young adults. It may cause tandem occlusions in which cervical carotid obstruction is associated with intracranial proximal vessel occlusion. To date, no consensus has emerged concerning endovascular treatment strategy. Our aim was to evaluate our endovascular "distal-to-proximal" strategy in the treatment of this stroke subtype in the first large multicentric cohort. MATERIALS AND METHODS: Prospectively managed stroke data bases from 2 separate centers were retrospectively studied between 2009 and 2014 for records of tandem occlusions related to internal carotid dissection. Atheromatous tandem occlusions were excluded. The first step in the revascularization procedure was intracranial thrombectomy. Then, cervical carotid stent placement was performed depending on the functionality of the circle of Willis and the persistence of residual cervical ICA occlusion, severe stenosis, or thrombus apposition. Efficiency, complications, and radiologic and clinical outcomes were recorded. RESULTS: Thirty-four patients presenting with tandem occlusion stroke secondary to internal carotid dissection were treated during the study period. The mean age was 52.5 years, the mean initial NIHSS score was 17.29 ± 6.23, and the mean delay between onset and groin puncture was 3.58 ± 1.1 hours. Recanalization TICI 2b/3 was obtained in 21 cases (62%). Fifteen patients underwent cervical carotid stent placement. There was no recurrence of ipsilateral stroke in the nonstented subgroup. Twenty-one patients (67.65%) had a favorable clinical outcome after 3 months. CONCLUSIONS: Endovascular treatment of internal carotid dissection-related tandem occlusion stroke using the distal-to-proximal recanalization strategy appears to be feasible, with low complication rates and considerable rates of successful recanalization.
BACKGROUND AND PURPOSE: Internal carotid dissection is a frequent cause of ischemic stroke in young adults. It may cause tandem occlusions in which cervical carotid obstruction is associated with intracranial proximal vessel occlusion. To date, no consensus has emerged concerning endovascular treatment strategy. Our aim was to evaluate our endovascular "distal-to-proximal" strategy in the treatment of this stroke subtype in the first large multicentric cohort. MATERIALS AND METHODS: Prospectively managed stroke data bases from 2 separate centers were retrospectively studied between 2009 and 2014 for records of tandem occlusions related to internal carotid dissection. Atheromatous tandem occlusions were excluded. The first step in the revascularization procedure was intracranial thrombectomy. Then, cervical carotid stent placement was performed depending on the functionality of the circle of Willis and the persistence of residual cervical ICA occlusion, severe stenosis, or thrombus apposition. Efficiency, complications, and radiologic and clinical outcomes were recorded. RESULTS: Thirty-four patients presenting with tandem occlusion stroke secondary to internal carotid dissection were treated during the study period. The mean age was 52.5 years, the mean initial NIHSS score was 17.29 ± 6.23, and the mean delay between onset and groin puncture was 3.58 ± 1.1 hours. Recanalization TICI 2b/3 was obtained in 21 cases (62%). Fifteen patients underwent cervical carotid stent placement. There was no recurrence of ipsilateral stroke in the nonstented subgroup. Twenty-one patients (67.65%) had a favorable clinical outcome after 3 months. CONCLUSIONS: Endovascular treatment of internal carotid dissection-related tandem occlusion stroke using the distal-to-proximal recanalization strategy appears to be feasible, with low complication rates and considerable rates of successful recanalization.
Authors: G Adam; J Darcourt; M Roques; M Ferrier; R Gramada; Z Meluchova; S Patsoura; A Viguier; C Cognard; V Larrue; F Bonneville Journal: AJNR Am J Neuroradiol Date: 2020-01-16 Impact factor: 3.825
Authors: Tomas Klail; Christoph Kurmann; Johannes Kaesmacher; Adnan Mujanovic; Eike I Piechowiak; Tomas Dobrocky; Sara Pilgram-Pastor; Adrian Scutelnic; Mirjam R Heldner; Jan Gralla; Pasquale Mordasini Journal: Clin Neuroradiol Date: 2022-09-07 Impact factor: 3.156