Adrien Ter Schiphorst1, Roxane Peres2, Cyril Dargazanli3, Raphaël Blanc4, Benjamin Gory5, Sébastien Richard6, Gaultier Marnat7, Igor Sibon8, Benoit Guillon9, Romain Bourcier10, Christian Denier11, Laurent Spelle12, Julien Labreuche13, Arturo Consoli14, Bertrand Lapergue15, Vincent Costalat3, Michael Obadia2, Caroline Arquizan16. 1. Department of Neurology, CHRU Gui de Chauliac, University Hospital of Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, France. 2. Department of Neurology, Fondation Rothschild Hospital, Paris, France. 3. Department of Interventional Neuroradiology, CHRU Gui de Chauliac, University Hospital of Montpellier, Montpellier, France. 4. Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France. 5. Department of Diagnostic and Therapeutic Neuroradiology, INSERM U1254, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France. 6. Department of Neurology, Stroke Unit, INSERM U1116, 54000, Nancy, France. 7. Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France. 8. Department of Neurology, Stroke Center, University Hospital of Bordeaux, Bordeaux, France. 9. Department of Neurology, University Hospital of Nantes, Nantes, France. 10. Department of Neuroradiology, University Hospital of Nantes, Nantes, France. 11. Department of Neurology, CHU Bicêtre, Le Kremlin Bicêtre, France. 12. Department of Interventional Neuroradiology, CHU Bicêtre, Le Kremlin Bicêtre, France. 13. ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Université de Lille, CHU Lille, 59000, Lille, France. 14. Department of Neuroradiology, Foch Hospital, Suresnes, France. 15. Department of Neurology, Foch Hospital, Suresnes, France. 16. Department of Neurology, CHRU Gui de Chauliac, University Hospital of Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, France. c-arquizan@chu-montpellier.fr.
Abstract
BACKGROUND: The best treatment for acute ischemic stroke (AIS) due to isolated cervical internal carotid artery occlusion (CICAO) (i.e., without associated occlusion of the circle of Willis) is still unknown. In this study, we aimed to describe EVT safety and clinical outcome in patients with CICAO. METHODS: We analyzed data of all consecutive patients, included in the Endovascular Treatment in Ischemic Stroke (ETIS) Registry between 2013 and 2020, who presented AIS and proven CICAO on angiogram and underwent EVT. We assessed carotid recanalization, procedural complications, National Institutes of Health Stroke Scale (NIHSS) at 24 h post-EVT, and 3-month favorable outcome (modified Rankin Scale, mRS ≤ 2 or equal to the pre-stroke value). RESULTS: Forty-five patients were included (median age: 70 years; range: 62-82 years). The median NIHSS before EVT was 14 (9-21). Carotid stenting was performed in 23 (51%) patients. Carotid recanalization at procedure end and on control imaging was observed in 37 (82%) and 29 (70%) patients, respectively. At day 1 post-EVT, the NIHSS remained stable or decreased in 25 (60%) patients; 12 (29%) patients had early neurologic deterioration (NIHSS ≥ 4 points). The rate of procedural complications was 36%, including stent thrombosis (n = 7), intracranial embolism (n = 7), and symptomatic intracranial hemorrhage (n = 1). At 3 months, 18 (40%) patients had a favorable outcome, and 10 (22%) were dead. CONCLUSION: Our study suggests that EVT in AIS patients with moderate/severe initial deficit due to CICAO led to high rate of recanalization at day 1, and a 40% rate of favorable outcome at 3 months. There was a high rate of procedural complication which is of concern. Randomized controlled trials assessing the superiority of EVT in patients with CICAO and severe deficits are needed.
BACKGROUND: The best treatment for acute ischemic stroke (AIS) due to isolated cervical internal carotid artery occlusion (CICAO) (i.e., without associated occlusion of the circle of Willis) is still unknown. In this study, we aimed to describe EVT safety and clinical outcome in patients with CICAO. METHODS: We analyzed data of all consecutive patients, included in the Endovascular Treatment in Ischemic Stroke (ETIS) Registry between 2013 and 2020, who presented AIS and proven CICAO on angiogram and underwent EVT. We assessed carotid recanalization, procedural complications, National Institutes of Health Stroke Scale (NIHSS) at 24 h post-EVT, and 3-month favorable outcome (modified Rankin Scale, mRS ≤ 2 or equal to the pre-stroke value). RESULTS: Forty-five patients were included (median age: 70 years; range: 62-82 years). The median NIHSS before EVT was 14 (9-21). Carotid stenting was performed in 23 (51%) patients. Carotid recanalization at procedure end and on control imaging was observed in 37 (82%) and 29 (70%) patients, respectively. At day 1 post-EVT, the NIHSS remained stable or decreased in 25 (60%) patients; 12 (29%) patients had early neurologic deterioration (NIHSS ≥ 4 points). The rate of procedural complications was 36%, including stent thrombosis (n = 7), intracranial embolism (n = 7), and symptomatic intracranial hemorrhage (n = 1). At 3 months, 18 (40%) patients had a favorable outcome, and 10 (22%) were dead. CONCLUSION: Our study suggests that EVT in AIS patients with moderate/severe initial deficit due to CICAO led to high rate of recanalization at day 1, and a 40% rate of favorable outcome at 3 months. There was a high rate of procedural complication which is of concern. Randomized controlled trials assessing the superiority of EVT in patients with CICAO and severe deficits are needed.
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