Endovascular Treatment for Acute Isolated Internal Carotid Artery Occlusion

被引:7
作者
Kaiser, Daniel P. O. [1 ,2 ]
Reiff, Tilman [3 ]
Mansmann, Ulrich [4 ]
Schoene, Daniela [2 ,5 ]
Strambo, Davide [6 ,7 ]
Michel, Patrik [6 ,7 ]
Abdalkader, Mohamad [8 ]
Nguyen, Thanh N. [9 ]
Gawlitza, Matthias [10 ]
Moehlenbruch, Markus A. [11 ]
Ringleb, Peter A. [3 ]
Puetz, Volker [2 ,5 ]
Gerber, Johannes C. [1 ,2 ]
Nagel, Simon [3 ,12 ]
机构
[1] Tech Univ Dresden, Univ Hosp Carl Gustav Carus, Inst Neuroradiol, Fac Med, Fetscherstre 74, D-01307 Dresden, Germany
[2] Univ Hosp Carl Gustav Carus, Dresden Neurovasc Ctr, Dresden, Germany
[3] Heidelberg Univ Hosp, Dept Neurol, Heidelberg, Germany
[4] Ludwig Maximilians Univ Munchen, Inst Med Informat Biometry & Epidemiol, Munich, Germany
[5] Univ Hosp Carl Gustav Carus, Dept Neurol, Dresden, Germany
[6] Lausanne Univ Hosp, Dept Clin Neurosci, Lausanne, Switzerland
[7] Univ Lausanne, Lausanne, Switzerland
[8] Boston Univ, Boston Med Ctr, Chobanian & Avedisian Sch Med, Dept Radiol, Boston, MA USA
[9] Boston Univ, Boston Med Ctr, Chobanian & Avedisian Sch Med, Div Intervent Neurol Neuroradiol, Boston, MA USA
[10] Univ Hosp Leipzig, Dept Neuroradiol, Leipzig, Germany
[11] Heidelberg Univ Hosp, Dept Neuroradiol, Heidelberg, Germany
[12] Dept Neurol, Klinikum Ludwigshafen, Ludwigshafen, Germany
关键词
Stroke; Intervention; Thrombectomy; Angiography; Cervical; ISCHEMIC-STROKE; THROMBECTOMY;
D O I
10.1007/s00062-023-01342-7
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
PurposeThe benefit of endovascular treatment (EVT) in patients with acute symptomatic isolated occlusion of the internal carotid artery (ICA) without involvement of the middle and anterior cerebral arteries is unclear. We aimed to compare clinical and safety outcomes of best medical treatment (BMT) versus EVT + BMT in patients with stroke due to isolated ICA occlusion.MethodsWe conducted a retrospective multicenter study involving patients with isolated ICA occlusion between January 2016 and December 2020. We stratified patients by BMT versus EVT and matched the groups using propensity score matching (PSM). We assessed the effect of treatment strategy on favorable outcome (modified Rankin scale & LE; 2) 90 days after treatment and compared reduction in NIHSS score at discharge, rates of symptomatic intracranial hemorrhage (sICH) and 3-month mortality.ResultsIn total, we included 149 patients with isolated ICA occlusion. To address imbalances, we matched 45 patients from each group using PSM. The rate of favorable outcomes at 90 days was 56% for EVT and 38% for BMT (odds ratio, OR 1.89, 95% confidence interval, CI 0.84-4.24; p = 0.12). Patients treated with EVT showed a median reduction in NIHSS score at discharge of 6 points compared to 1 point for BMT patients (p = 0.02). Rates of symptomatic intracranial hemorrhage (7% vs. 4%; p = 0.66) and 3-month mortality (11% vs. 13%; p = 0.74) did not differ between treatment groups. Periprocedural complications of EVT with early neurological deterioration occurred in 7% of cases.ConclusionAlthough the benefit on functional outcome did not reach statistical significance, the results for NIHSS score improvement, and safety support the use of EVT in patients with stroke due to isolated ICA occlusion.
引用
收藏
页码:125 / 133
页数:9
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