Fabrizio Sallustio1,2, Giovanni Pracucci3, Manuel Cappellari4, Valentina Saia5, Alfredo Paolo Mascolo6, Federico Marrama6, Roberto Gandini7, Giacomo Koch6,8, Marina Diomedi6, Federica D'Agostino6, Alessandro Rocco6, Valerio Da Ros7, Andrea Wlderk7, Marco Nezzo7, Renato Argirò7, Daniele Morosetti7, Leonardo Renieri9, Patrizia Nencini3, Stefano Vallone10, Andrea Zini11, Guido Bigliardi12, Antonio Pitrone13, Francesco Grillo14, Sandra Bracco15, Rossana Tassi16, Mauro Bergui17, Andrea Naldi18, Giuseppe Carità19, Ilaria Casetta20, Roberto Gasparotti21, Mauro Magoni22, Luigi Simonetti23, Nicolò Haznedari24, Matteo Paolucci25, Nicola Mavilio26, Laura Malfatto27, Roberto Menozzi28, Antonio Genovese29, Mirco Cosottini30, Giovanni Orlandi31, Alessio Comai32, Enrica Franchini33, Alessandro Pedicelli34, Giovanni Frisullo35, Edoardo Puglielli36, Alfonsina Casalena37, Giacomo Cester38, Claudio Baracchini39, Davide Castellano40, Alessandra Di Liberto41, Giuseppe Kenneth Ricciardi42, Luigi Chiumarulo43, Marco Petruzzellis44, Elvis Lafe45, Alessandra Persico46, Nicola Cavasin47, Adriana Critelli48, Vittorio Semeraro49, Angelica Tinelli50, Andrea Giorgianni51, Federico Carimati52, William Auteri53, Stefano Rizzuto54, Francesco Biraschi55, Ettore Nicolini56, Antonio Ferrari57, Maurizio Melis58, Stefano Calia59, Tiziana Tassinari5, Nunzio Paolo Nuzzi60, Manuel Corato61, Simona Sacco62, Guido Squassina63, Paolo Invernizzi64, Ivan Gallesio65, Luigi Ruiz66, Giovanni Dui67, Nicola Carboni68, Pietro Amistà69, Monia Russo70, Mario Maiore71, Bastianina Zanda72, Giuseppe Craparo73, Marina Mannino74, Domenico Inzitari3, Danilo Toni56, Salvatore Mangiafico9. 1. Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133, Rome, Italy. fsall75@gmail.com. 2. Department of Clinical and Behavioural Neurology, Santa Lucia Foundation IRCCS, Rome, Italy. fsall75@gmail.com. 3. Stroke Unit, Ospedale Careggi-University Hospital, Florence, Italy. 4. Stroke Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. 5. Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy. 6. Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133, Rome, Italy. 7. Interventional Radiology Unit, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy. 8. Department of Clinical and Behavioural Neurology, Santa Lucia Foundation IRCCS, Rome, Italy. 9. Interventional Neuroradiology Unit, Ospedale Careggi-University Hospital, Florence, Italy. 10. Neuroradiology Unit, Ospedale Civile S. Agostino-Estense University Hospital, Modena, Italy. 11. Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy. 12. Neurology Unit, Ospedale Civile S. Agostino-Estense University Hospital, Modena, Italy. 13. Neuroradiology Unit, Azienda Ospedaliera Universitaria Policlinico Messina, Messina, Italy. 14. Stroke Unit, Azienda Ospedaliera Universitaria Policlinico Messina, Messina, Italy. 15. Interventional Neuroradiology Unit, Ospedale S. Maria Delle Scotte-University Hospital, Siena, Italy. 16. Stroke Unit, Ospedale S. Maria Delle Scotte-University Hospital, Siena, Italy. 17. Interventional Neuroradiology Unit, Città della Salute e della Scienza-Molinette, Turin, Italy. 18. Stroke Unit, Città della Salute e della Scienza-Molinette, Turin, Italy. 19. Interventional Neuroradiology Unit, Arcispedale S. Anna-University Hospital, Ferrara, Italy. 20. Neurology Division, Arcispedale S. Anna-University Hospital, Ferrara, Italy. 21. Neuroradiology Unit, Spedali Civili, Brescia, Italy. 22. Stroke Unit, Spedali Civili, Brescia, Italy. 23. Neuroradiology Unit, IRCCS Istituto Delle Scienze Neurologiche, Bellaria Hospital, Bologna, Italy. 24. Interventional Neuroradiology Unit, AUSL Romagna Cesena, Cesena, Italy. 25. Neurology and Stroke Unit, AUSL Romagna Cesena, Cesena, Italy. 26. Interventional Neuroradiology Unit, IRCCS San Martino-IST, Genoa, Italy. 27. Stroke Unit, IRCCS San Martino-IST, Genoa, Italy. 28. Interventional Neuroradiology Unit, Ospedale Universitario, Parma, Italy. 29. Programma Stroke Care, Ospedale Universitario, Parma, Italy. 30. Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy. 31. Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Pisa, Italy. 32. Radiology Unit, Ospedale Centrale, Bolzano, Italy. 33. Stroke Unit, Ospedale Centrale, Bolzano, Italy. 34. Interventional Radiology Unit, Fondazione Policlinico Gemelli, Rome, Italy. 35. Stroke Unit, Fondazione Policlinico Gemelli, Rome, Italy. 36. Interventional Radiology Unit, Ospedale Civile Mazzini, Teramo, Italy. 37. Neurology Unit, Ospedale Civile Mazzini, Teramo, Italy. 38. Neuroradiology Unit, Azienda Ospedaliero-Universitaria, Padua, Italy. 39. Stroke Unit, Azienda Ospedaliero-Universitaria, Padua, Italy. 40. Interventional Neuroradiology Unit, Ospedale San Giovanni Bosco, Turin, Italy. 41. Neurology Unit, Ospedale San Giovanni Bosco, Turin, Italy. 42. Neuroradiology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. 43. Interventional Neuroradiology Unit, AOU Consorziale Policlinico, Bari, Italy. 44. Neurology and Stroke Unit, AOU Consorziale Policlinico, Bari, Italy. 45. Diagnostic Radiology and Interventional Neuroradiology, IRCCS Policlinico San Matteo, Pavia, Italy. 46. Cerebrovascular Disease and Stroke Unit, IRCCS Fondazione Mondino, Pavia, Italy. 47. Neuroradiology Unit, Ospedale dell'Angelo, USSL3 Serenissima, Mestre, Italy. 48. Neurology Unit, Ospedale dell'Angelo, USSL3 Serenissima, Mestre, Italy. 49. Neuroradiology Unit, Osp. "SS. Annunziata"-ASL TA, Taranto, Italy. 50. Neurology Unit, Osp. "SS. Annunziata"-ASL TA, Taranto, Italy. 51. Neuroradiology Department, Ospedale di Circolo di Varese, ASST-Sette Laghi, Varese, Italy. 52. Neurology and Stroke Unit, Ospedale di Circolo di Varese, ASST-Sette Laghi, Varese, Italy. 53. Neuroradiology Unit, Azienda Ospedaliera Cosenza, Cosenza, Italy. 54. Stroke Unit, Azienda Ospedaliera Cosenza, Cosenza, Italy. 55. Interventional Neuroradiology Unit, University of Rome La Sapienza, Rome, Italy. 56. Stroke Unit, University of Rome La Sapienza, Rome, Italy. 57. Interventional Neuroradiology, Azienda Ospedaliera Brotzu, Cagliari, Italy. 58. Neuroscience Department, Azienda Ospedaliera Brotzu, Cagliari, Italy. 59. Neuroradiology Unit, Santa Corona Hospital, Pietra Ligure, Italy. 60. Neuroradiology Unit, IRCCS Humanitas Rozzano, Rozzano, Milano, Italy. 61. Stroke Unit, IRCCS Humanitas Rozzano, Rozzano, Milano, Italy. 62. Department of Clinical Sciences and Biotechnology, Avezzano, L'Aquila, Italy. 63. Neuroradiology Unit, Fondazione Poliambulanza, Brescia, Italy. 64. Stroke Unit, Fondazione Poliambulanza, Brescia, Italy. 65. Neuroradiology Unit, Azienda Ospedaliera "SS Antonio e Biagio e C. Arrigo", Alessandria, Italy. 66. Neurology Department, Azienda Ospedaliera "SS Antonio e Biagio e C. Arrigo", Alessandria, Italy. 67. Interventional Radiology, Ospedale San Francesco, Nuoro, Italy. 68. Neurology and Stroke Unit, Ospedale San Francesco, Nuoro, Italy. 69. Neuroradiology Unit, Ospedale S. Maria Misericordia, Rovigo, Italy. 70. Stroke Unit, Ospedale S. Maria Misericordia, Rovigo, Italy. 71. Neuroradiology Unit, Azienda Ospedaliera Universitaria SS Annunziata, Sassari, Italy. 72. Stroke Unit, Azienda Ospedaliera Universitaria SS Annunziata, Sassari, Italy. 73. Interventional Radiology, Ospedale Civico e Benfratelli, Palermo, Italy. 74. Neurology Unit, Ospedale Civico e Benfratelli, Palermo, Italy.
Abstract
PURPOSE: The management of tandem extracranial internal carotid artery and intracranial large vessel occlusion during endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) has been under-investigated. We sought to investigate outcomes of AIS patients with tandem occlusion (TO) treated with carotid artery stenting (CAS) compared to those not treated with CAS (no-CAS) during EVT. METHODS: We performed a cohort study using data from AIS patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. Outcomes were 3 months' mortality, functional outcome, complete and successful recanalization, any intracranial hemorrhage, parenchymal hematoma and symptomatic intracerebral hemorrhage. RESULTS: Among 466 AIS patients with TO, CAS patients were 122 and no-CAS patients were 226 (118 excluded). After adjustment for unbalanced variables, CAS was associated with a lower rate of 3 months' mortality (OR 0.407, 95% CI 0.171-0.969, p = 0.042). After adjustment for pre-defined variables, CAS was associated with a lower rate of 3 months' mortality (aOR 0.430, 95% CI 0.187-0.989, p = 0.047) and a higher rate of complete recanalization (aOR 1.986, 95% CI 1.121-3.518, p = 0.019), successful recanalization (aOR 2.433, 95% CI 1.263-4.686, p = 0.008) and parenchymal hematoma (aOR 2.876, 95% CI 1.173-7.050, p = 0.021). CAS was associated with lower 3 months mortality (OR 0.373, 95% CI 0.141-0.982, p = 0.046) and higher rates of successful recanalization (OR 2.082, 95% CI 1.099-3.942, p = 0.024) after adjustment for variables associated with 3 months' mortality and successful recanalization, respectively. CONCLUSIONS: Among AIS patients with TO, CAS during EVT was associated with a higher rate of successful reperfusion and a lower rate of 3 months' mortality.
PURPOSE: The management of tandem extracranial internal carotid artery and intracranial large vessel occlusion during endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) has been under-investigated. We sought to investigate outcomes of AIS patients with tandem occlusion (TO) treated with carotid artery stenting (CAS) compared to those not treated with CAS (no-CAS) during EVT. METHODS: We performed a cohort study using data from AIS patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. Outcomes were 3 months' mortality, functional outcome, complete and successful recanalization, any intracranial hemorrhage, parenchymal hematoma and symptomatic intracerebral hemorrhage. RESULTS: Among 466 AIS patients with TO, CAS patients were 122 and no-CAS patients were 226 (118 excluded). After adjustment for unbalanced variables, CAS was associated with a lower rate of 3 months' mortality (OR 0.407, 95% CI 0.171-0.969, p = 0.042). After adjustment for pre-defined variables, CAS was associated with a lower rate of 3 months' mortality (aOR 0.430, 95% CI 0.187-0.989, p = 0.047) and a higher rate of complete recanalization (aOR 1.986, 95% CI 1.121-3.518, p = 0.019), successful recanalization (aOR 2.433, 95% CI 1.263-4.686, p = 0.008) and parenchymal hematoma (aOR 2.876, 95% CI 1.173-7.050, p = 0.021). CAS was associated with lower 3 months mortality (OR 0.373, 95% CI 0.141-0.982, p = 0.046) and higher rates of successful recanalization (OR 2.082, 95% CI 1.099-3.942, p = 0.024) after adjustment for variables associated with 3 months' mortality and successful recanalization, respectively. CONCLUSIONS: Among AIS patients with TO, CAS during EVT was associated with a higher rate of successful reperfusion and a lower rate of 3 months' mortality.
Authors: G Marnat; M Bühlmann; O F Eker; J Gralla; P Machi; U Fischer; C Riquelme; M Arnold; A Bonafé; S Jung; V Costalat; P Mordasini Journal: AJNR Am J Neuroradiol Date: 2018-04-26 Impact factor: 3.825
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Authors: Mayank Goyal; Bijoy K Menon; Wim H van Zwam; Diederik W J Dippel; Peter J Mitchell; Andrew M Demchuk; Antoni Dávalos; Charles B L M Majoie; Aad van der Lugt; Maria A de Miquel; Geoffrey A Donnan; Yvo B W E M Roos; Alain Bonafe; Reza Jahan; Hans-Christoph Diener; Lucie A van den Berg; Elad I Levy; Olvert A Berkhemer; Vitor M Pereira; Jeremy Rempel; Mònica Millán; Stephen M Davis; Daniel Roy; John Thornton; Luis San Román; Marc Ribó; Debbie Beumer; Bruce Stouch; Scott Brown; Bruce C V Campbell; Robert J van Oostenbrugge; Jeffrey L Saver; Michael D Hill; Tudor G Jovin Journal: Lancet Date: 2016-02-18 Impact factor: 79.321
Authors: Jeffrey L Saver; Mayank Goyal; Alain Bonafe; Hans-Christoph Diener; Elad I Levy; Vitor M Pereira; Gregory W Albers; Christophe Cognard; David J Cohen; Werner Hacke; Olav Jansen; Tudor G Jovin; Heinrich P Mattle; Raul G Nogueira; Adnan H Siddiqui; Dileep R Yavagal; Blaise W Baxter; Thomas G Devlin; Demetrius K Lopes; Vivek K Reddy; Richard du Mesnil de Rochemont; Oliver C Singer; Reza Jahan Journal: N Engl J Med Date: 2015-04-17 Impact factor: 91.245
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: V Da Ros; J Scaggiante; F Sallustio; S Lattanzi; M Bandettini; A Sgreccia; C Rolla-Bigliani; E Lafe; G Sanfilippo; M Diomedi; M Ruggiero; N Haznedari; M Giannoni; C Finocchi; R Floris Journal: AJNR Am J Neuroradiol Date: 2020-09-24 Impact factor: 3.825