Clinical and safety outcomes of acute stenting plus thrombectomy for carotid tandem lesions with large ischemic core

医学 改良兰金量表 颈动脉支架置入术 优势比 脑出血 冲程(发动机) 置信区间 外科 病变 回顾性队列研究 内科学 缺血性中风 格拉斯哥昏迷指数 颈动脉内膜切除术 颈动脉 缺血 工程类 机械工程
作者
Yakub Deliktas,Imad Derraz,Stephanos Finitsis,Jildaz Caroff,Romain Bourcier,Sébastien Soize,Solène Moulin,Sébastien Richard,Gaultier Marnat,Matúš Hoferica,Christophe Cognard,Jean‐Philippe Desilles,Mohammad Anadani,Jean‐Marc Olivot,Barbara Casolla,Arturo Consoli,Bertrand Lapergue,Benjamin Gory
出处
期刊:Journal of NeuroInterventional Surgery [BMJ]
卷期号:: jnis-021517
标识
DOI:10.1136/jnis-2024-021517
摘要

Background We evaluated the clinical and safety outcomes of emergent carotid artery stenting (eCAS) plus endovascular thrombectomy (EVT) among patients with anterior tandem lesion (TL) and large ischemic core (LIC). Methods This retrospective study included consecutive stroke patients enrolled in the Endovascular Treatment in Ischemic Stroke Registry in France between January 2015 and June 2023. We compared the outcomes of carotid stenting vs no stenting in tandem lesion with pre-treatment LIC (Alberta Stroke Program Early CT Score (ASPECTS) 3–5) and stenting in tandem lesion vs thrombectomy alone for isolated intracranial occlusions with pre-treatment LIC. Primary outcome was a score of 0 to 3 on the modified Rankin scale (mRS) at 90 days. Multivariable mixed-effects logistic regression was performed. Results Among 218 tandem patients with LIC, 55 were treated with eCAS plus EVT. The eCAS group had higher odds of 90-day mRS 0–3 (adjusted Odds Ratio (aOR) 2.40, 95% confidence interval (CI) 1.10 to 5.21; p=0.027). There were no differences in the risk of any intracerebral hemorrhage (OR 1.41, 95% CI 0.69 to 2.86; p=0.346), parenchymal hematoma (aOR 1.216, 95% CI 0.49 to 3.02; p=0.675), symptomatic intracerebral hemorrhage (aOR 1.45, 95% CI 0.60 to 3.48; p=0.409), or 90-day mortality (aOR 0.74, 95% CI 0.33 to 1.68; p=0.472). eCAS was associated with a higher rate of carotid patency at day 1 (aOR 3.54, 95% CI 1.14 to 11.01; p=0.028). Safety outcomes were similar between EVT+eCAS group in TL-LIC and EVT alone group in isolated intracranial occlusions with LIC. Conclusion eCAS appears to be a safe and effective strategy in patients with TL and LIC volume.
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