Sandra Bracco1, Matteo Zanoni2, Tommaso Casseri1, Davide Castellano3, Samuele Cioni1, Ignazio Maria Vallone1, Paola Gennari1, Maria Antonietta Mazzei4, Daniele Giuseppe Romano5, Mariangela Piano6, Chiara Comelli3, Rossana Tassi7, Elisa Francesca Maria Ciceri8. 1. Unit of Interventional Neuroradiology, Department of Neurology and Human Movement Sciences, Azienda Ospedaliera Universitaria Senese, Siena, Italy. 2. Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences, University of Siena, Azienda Ospedaliera Universitaria Senese, Santa Maria Alle Scotte Hospital, Viale M. Bracci 16, 53100, Siena, Italy. matteo.zanoni.91@gmail.com. 3. Department of Interventional Radiology and Neuroradiology, S. Giovanni Bosco Hospital, Azienda Sanitaria Locale Città di Torino, Turin, Italy. 4. Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences, University of Siena, Azienda Ospedaliera Universitaria Senese, Santa Maria Alle Scotte Hospital, Viale M. Bracci 16, 53100, Siena, Italy. 5. Neuroradiology Unit, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy. 6. Neuroradiology Department, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy. 7. Stroke Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy. 8. Neuroradiology Department, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
Abstract
PURPOSE: Acute ischemic stroke (AIS) due to tandem lesions (TLs) of extracranial Internal Carotid Artery and Anterior Cerebral Circulation are challenging for endovascular treatment (EVT). This study aims to evaluate feasibility, safety and efficacy of EVT for TLs' AIS, with or without emergent carotid artery stenting (eCAS), in a real-life scenario. METHODS: Retrospective review of prospectively collected non-randomized thrombectomy databases from five stroke centers between 2015 and 2019. Consecutive patients with TLs' AIS were selected. Clinical, neuroimage and procedure features, as well as antiplatelet therapy regimen, were evaluated. Primary outcome was 90-day mRS ≤ 2. Secondary outcomes included: mTICI score 2b-3, extracranial recanalization, procedural complications, symptomatic intracerebral hemorrhage (SICH) and 90-day mortality. RESULTS: Two hundred twenty-seven patients were enrolled (67.8% males; mean age 65.9 ± 12.9 years). We obtained mTICI 2b-3 in 77.1%, extracranial recanalization in 86.8%, 90-day mRS (available in 201/227 cases) ≤ 2 in 49.8%. Procedural complications occurred in 16.7%, SICH in 9.7%; 90-day mortality rate (available in 201/227 cases) was 14.4%. The strongest predictors of good clinical outcome were young age (p < 0.0001), low baseline NIHSS (p = 0.008), high baseline ASPECTS (p < 0.0001), good collateral flow (p = 0.013) and extracranial recanalization (p = 0.001). The most significant predictors of SICH were low baseline ASPECTS (p < 0.0001), occurrence of complications (p < 0.0001) and eCAS (p = 0.002). CONCLUSION: In our real-life series, the EVT for TLs' AIS was feasible, safe and effective in improving 90-day functional outcome with acceptable morbi-mortality rates. ECAS increased the risk of SICH, independently from the antiplatelet therapy regimen.
PURPOSE: Acute ischemic stroke (AIS) due to tandem lesions (TLs) of extracranial Internal Carotid Artery and Anterior Cerebral Circulation are challenging for endovascular treatment (EVT). This study aims to evaluate feasibility, safety and efficacy of EVT for TLs' AIS, with or without emergent carotid artery stenting (eCAS), in a real-life scenario. METHODS: Retrospective review of prospectively collected non-randomized thrombectomy databases from five stroke centers between 2015 and 2019. Consecutive patients with TLs' AIS were selected. Clinical, neuroimage and procedure features, as well as antiplatelet therapy regimen, were evaluated. Primary outcome was 90-day mRS ≤ 2. Secondary outcomes included: mTICI score 2b-3, extracranial recanalization, procedural complications, symptomatic intracerebral hemorrhage (SICH) and 90-day mortality. RESULTS: Two hundred twenty-seven patients were enrolled (67.8% males; mean age 65.9 ± 12.9 years). We obtained mTICI 2b-3 in 77.1%, extracranial recanalization in 86.8%, 90-day mRS (available in 201/227 cases) ≤ 2 in 49.8%. Procedural complications occurred in 16.7%, SICH in 9.7%; 90-day mortality rate (available in 201/227 cases) was 14.4%. The strongest predictors of good clinical outcome were young age (p < 0.0001), low baseline NIHSS (p = 0.008), high baseline ASPECTS (p < 0.0001), good collateral flow (p = 0.013) and extracranial recanalization (p = 0.001). The most significant predictors of SICH were low baseline ASPECTS (p < 0.0001), occurrence of complications (p < 0.0001) and eCAS (p = 0.002). CONCLUSION: In our real-life series, the EVT for TLs' AIS was feasible, safe and effective in improving 90-day functional outcome with acceptable morbi-mortality rates. ECAS increased the risk of SICH, independently from the antiplatelet therapy regimen.
Authors: Ashutosh P Jadhav; Osama O Zaidat; David S Liebeskind; Dileep R Yavagal; Diogo C Haussen; Frank R Hellinger; Reza Jahan; Mouhammad A Jumaa; Viktor Szeder; Raul G Nogueira; Tudor G Jovin Journal: Stroke Date: 2019-02 Impact factor: 7.914
Authors: Marta Rubiera; Marc Ribo; Raquel Delgado-Mederos; Esteban Santamarina; Pilar Delgado; Joan Montaner; José Alvarez-Sabín; Carlos A Molina Journal: Stroke Date: 2006-08-03 Impact factor: 7.914
Authors: Mitchell P Wilson; Mohammad H Murad; Timo Krings; Vitor M Pereira; Cian O'Kelly; Jeremy Rempel; Christopher A Hilditch; Waleed Brinjikji Journal: J Neurointerv Surg Date: 2018-03-09 Impact factor: 5.836
Authors: G G Ferguson; M Eliasziw; H W Barr; G P Clagett; R W Barnes; M C Wallace; D W Taylor; R B Haynes; J W Finan; V C Hachinski; H J Barnett Journal: Stroke Date: 1999-09 Impact factor: 7.914
Authors: Olvert A Berkhemer; Puck S S Fransen; Debbie Beumer; Lucie A van den Berg; Hester F Lingsma; Albert J Yoo; Wouter J Schonewille; Jan Albert Vos; Paul J Nederkoorn; Marieke J H Wermer; Marianne A A van Walderveen; Julie Staals; Jeannette Hofmeijer; Jacques A van Oostayen; Geert J Lycklama à Nijeholt; Jelis Boiten; Patrick A Brouwer; Bart J Emmer; Sebastiaan F de Bruijn; Lukas C van Dijk; L Jaap Kappelle; Rob H Lo; Ewoud J van Dijk; Joost de Vries; Paul L M de Kort; Willem Jan J van Rooij; Jan S P van den Berg; Boudewijn A A M van Hasselt; Leo A M Aerden; René J Dallinga; Marieke C Visser; Joseph C J Bot; Patrick C Vroomen; Omid Eshghi; Tobien H C M L Schreuder; Roel J J Heijboer; Koos Keizer; Alexander V Tielbeek; Heleen M den Hertog; Dick G Gerrits; Renske M van den Berg-Vos; Giorgos B Karas; Ewout W Steyerberg; H Zwenneke Flach; Henk A Marquering; Marieke E S Sprengers; Sjoerd F M Jenniskens; Ludo F M Beenen; René van den Berg; Peter J Koudstaal; Wim H van Zwam; Yvo B W E M Roos; Aad van der Lugt; Robert J van Oostenbrugge; Charles B L M Majoie; Diederik W J Dippel Journal: N Engl J Med Date: 2014-12-17 Impact factor: 91.245
Authors: Randall T Higashida; Anthony J Furlan; Heidi Roberts; Thomas Tomsick; Buddy Connors; John Barr; William Dillon; Steven Warach; Joseph Broderick; Barbara Tilley; David Sacks Journal: Stroke Date: 2003-07-17 Impact factor: 7.914
Authors: Zarina Assis; Bijoy K Menon; Mayank Goyal; Andrew M Demchuk; Jai Shankar; Jeremy L Rempel; Daniel Roy; Alexander Y Poppe; Victor Yang; Cheemun Lum; Dar Dowlatshahi; John Thornton; Hana Choe; Paul A Burns; Donald F Frei; Blaise W Baxter; Michael D Hill Journal: J Neurointerv Surg Date: 2017-10-11 Impact factor: 5.836