Emergent Carotid Stenting During Thrombectomy in Tandem Occlusions Secondary to Dissection: A STOP-CAD Secondary Study

医学 改良兰金量表 颈动脉支架置入术 冲程(发动机) 闭塞 外科 四分位间距 椎动脉剥离术 解剖(医学) 回顾性队列研究 优势比 内科学 缺血 颈动脉 颈动脉内膜切除术 缺血性中风 机械工程 工程类
作者
João André Sousa,Marc Rodrigo‐Gisbert,Liqi Shu,Allison Luo,Han Xiao,Noor Mahmoud,Asghar Shah,Ana Luyza Oliveira Santos,Michael P. Moore,Daniel Mandel,Mirjam R. Heldner,Vasco Barata,Sara Bernardo-Castro,Nils Henninger,Jayachandra Muppa,Marcel Arnold,Ahmad Nehme,Aaron Rothstein,Ossama Khazaal,Josefin Emelie Kaufmann
出处
期刊:Stroke [Lippincott Williams & Wilkins]
标识
DOI:10.1161/strokeaha.124.048295
摘要

Background: The optimal endovascular management of cervical carotid dissection causing tandem occlusion remains uncertain. We investigated the impact of emergent carotid stenting during endovascular treatment (EVT) for acute ischemic stroke (AIS) in patients with tandem occlusion secondary to cervical carotid artery dissection. Methods: This was a secondary analysis of patients treated with EVT for AIS due to occlusive carotid artery dissection and tandem occlusion included in the retrospective international Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection (STOP-CAD) study. We compared patients with and without emergent stenting. The primary efficacy and safety outcomes were 90-day functional independence (modified Rankin Scale 0-2) and symptomatic intracranial hemorrhage (sICH) within 24h after EVT. Procedural outcome was successful intracranial recanalization (mTICI 2b/3). We used mixed-effect logistic regression adjusting for site, age, and NIHSS. In additional analyses, we used inverse probability of treatment weighting and adjusted for ASPECTS. Results: Of the 4023 patients enrolled in STOP-CAD, 328 presented with anterior circulation AIS due to tandem occlusion and underwent EVT. The median age was 51 years (interquartile range 44-58), and 96 patients (29.3%) were female. One hundred fifty patients (45.7%) underwent emergent stenting. There was no significant association between stenting and 90-day functional independence (62.0% vs 59.7%; aOR 1.23, 95% CI 0.82-1.86, p=0.315) or sICH (7.3% vs 7.9%; aOR OR 0.95, 95% CI 0.41-2.2, p=0.913). Emergent carotid stenting was associated with successful intracranial recanalization (81.8% vs 76.6% aOR 2.62, 95% CI 1.52-4.5, p<0.001). Results did not meaningfully change in additional analyses. Conclusion: In patients presenting with an acute anterior circulation tandem occlusion secondary to cervical carotid artery dissection, emergent stenting was associated with a higher likelihood of successful intracranial recanalization but not improved functional outcomes or increased sICH. It remains unclear whether emergent stenting led to successful intracranial recanalization or patients with successful intracranial recanalization were more likely to be stented. Randomized trials are warranted.
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