Endovascular treatment of patients with acute ischemic stroke and tandem occlusion due to internal carotid artery dissection: A multicenter experience

被引：7

作者：

Da Ros, Valerio ^{[1
]}

Pusceddu, Federica ^{[1
]}

Lattanzi, Simona ^{[2
]}

Scaggiante, Jacopo ^{[3
]}

Sallustio, Fabrizio ^{[4
]}

Marrama, Federico ^{[4
]}

di Poggio, Monica Bandettini ^{[5
]}

Toscano, Gianpaolo ^{[6
]}

Di Giuliano, Francesca ^{[1
]}

Rolla-Bigliani, Claudia ^{[7
]}

Ruggiero, Maria ^{[8
]}

Haznedari, Niccolo ^{[8
]}

Sgreccia, Alessandro ^{[9
]}

Sanfilippo, Giuseppina ^{[10
]}

Finocchi, Cinzia ^{[5
]}

Diomedi, Marina ^{[11
]}

Tomasi, Santino O. ^{[12
,13
]}

Palmisciano, Paolo ^{[14
]}

Umana, Giuseppe E. ^{[14
]}

Strigari, Lidia ^{[15
]}

Griessenauer, Christoph J. ^{[12
,16
,17
]}

Pitocchi, Francesca ^{[1
]}

Garaci, Francesco ^{[1
]}

Floris, Roberto ^{[1
]}

机构：

[1] Univ Roma Tor Vergata, Dept Biomed & Prevent, Diagnost Imaging Unit, Rome, Italy

[2] Marche Polytech Univ, Dept Expt & Clin Med, Neurol Clin, Ancona, Italy

[3] Med Univ South Carolina, Dept Radiol & Radiol Sci, Charleston, SC 29425 USA

[4] Univ Roma Tor Vergata, Comprehens Stroke Ctr, Rome, Italy

[5] Univ Genoa, Policlin Hosp San Martino, Dept Neurosci, Genoa, Italy

[6] Univ Policlin San Matteo, IRCCS Mondino Fundat, Stroke Unit, Milan, Italy

[7] Univ Hosp, Dept Diagnost & Intervent Neuroradiol, San Martino Buon Albergo, Italy

[8] AUSL Romagna, Neuroradiol Unit, Ravenna, Italy

[9] AOU Osped Riuniti Ancona, Clin Neuroradiol & Intervent Neuroradiol, Ancona, Italy

[10] IRCCS Policlin San Matteo, Dept Diagnost & Intervent Radiol & Neuroradiol, Milan, Italy

[11] Univ Roma Tor Vergata, Dept Syst Med, Rome, Italy

[12] Paracelsus Med Univ, Dept Neurol Surg, Christian Doppler Klin, Salzburg, Austria

[13] Paracelsus Med Univ, Christian Doppler Klin, Lab Microsurg Neuroanat, Salzburg, Austria

[14] Cannizzaro Hosp, Dept Neurosurg, Trauma & Gamma Knife Ctr, Catania, Italy

[15] IRCCS Azienda Osped Univ Bologna, Dept Med Phys, Bologna, Italy

[16] Geisinger Hlth Syst, Dept Neurosurg, Danville, PA USA

[17] Paracelsus Med Univ, Res Inst Neurointervent, Salzburg, Austria

来源：

NEURORADIOLOGY JOURNAL | 2023年 / 36卷 / 01期

关键词：

Endovascular; Internal carotid artery dissection; Interventional; Ischemic stroke; Stroke; Tandem occlusion; Thrombectomy; MANAGEMENT; THROMBECTOMY; GUIDELINES; LESIONS;

D O I：

10.1177/19714009221108673

中图分类号：

R445 [影像诊断学];

学科分类号：

100207 ;

摘要：

Background: The optimal management of patients with acute ischemic stroke (AIS) due to tandem occlusion (TO) and underlying carotid dissection (CD) remains unclear. Objective: We present our multicenter-experience of endovascular treatment (EVT) approach used and outcomes for AIS patients with CD-related TO (CD-TO). Methods: Consecutive AIS patients underwent EVT for CD-TO at five Italian Neuro-interventional Tertiary Stroke Centers were retrospectively identified. TO from atherosclerosis and other causes of, were excluded from the final analysis. Primary outcome was successful (mTICI 2b-3) and complete reperfusion (mTICI 3); secondary outcome was patients' 3-months functional independence (mRS <= 2). Results: Among 214 AIS patients with TO, 45 presented CD-TO. Median age was 54 years (range 29-86), 82.2% were male. Age <65 years (p < 0.0001), lower baseline NIHSS score (p = 0.0002), and complete circle of Willis (p = 0.0422) were associated with mRS <= 2 at the multivariate analysis. Comparisons between antegrade and retrograde approaches resulted in differences for baseline NIHSS scores (p = 0.001) and number of EVT attempts per-procedure (p = 0.001). No differences in terms of recanalization rates were observed between antegrade and retrograde EVT approaches (p = 0.811) but higher rates of mTICI3 revascularization was observed with the retrograde compared to the antegrade approach (78.6% vs 73.3%), anyway not statistically significant. CD management technique (angioplasty vs aspiration vs emergent stenting) did not correlate with 3-months mRS <= 2. Conclusion: AIS patients with CD-TO were mostly treated with the retrograde approach with lower number of attempts perprocedure but it offered similar recanalization rates compared with the antegrade approach. Emergent carotid artery stenting (CAS) proved to be safe for CD management but it does not influence 3-months patients' clinical outcomes.

引用

页码：86 / 93

页数：8

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