Mechanical thrombectomy in acute ischemic stroke with tandem occlusions: impact of extracranial carotid lesion etiology on endovascular management and outcome

被引：16

作者：

Da Ros, Valerio ^{[1
]}

Scaggiante, Jacopo ^{[1
,13
]}

Pitocchi, Francesca ^{[1
]}

Sallustio, Fabrizio ^{[2
]}

Lattanzi, Simona ^{[3
]}

Umana, Giuseppe Emmanuele ^{[4
]}

Chaurasia, Bipin ^{[5
]}

di Poggio, Monica Bandettini ^{[6
]}

Toscano, Gianpaolo ^{[7
]}

Bigliani, Claudia Rolla ^{[8
]}

Ruggiero, Maria ^{[9
]}

Haznedari, Nicolo ^{[9
]}

Sgreccia, Alessandro ^{[10
]}

Sanfilippo, Giuseppina ^{[11
]}

Diomedi, Marina ^{[12
]}

Finocchi, Cinzia ^{[6
]}

Floris, Roberto ^{[1
]}

机构：

[1] Univ Roma Tor Vergata, Dept Biomed, Intervent Neuroradiol Unit, Rome, Italy

[2] Tor Vergata Univ Hosp, Comprehens Stroke Ctr, Rome, Italy

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

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

[5] Bangabandhu Sheikh Mujib Med Univ, Dept Neurosurg, Dhaka, Bangladesh

[6] Univ Genoa, Osped Policlin San Martino, Dept Neurosci Rehabil Ophthalmol Genet Maternal &, Genoa, Italy

[7] IRCCS Mondino Fdn, Stroke Unit Policlin San Matteo, Pavia, Italy

[8] Policlin Univ San Martino, Dept Diagnost & Intervent Neuroradiol, Genoa, Italy

[9] AUSL Romagna, Neuroradiol Unit, Cesena, Italy

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

[11] IRCCS Policlin San Matteo, Dept Diagnost & Intervent Radiol & Neuroradiol, Pavia, Italy

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

[13] Med Univ South Carolina, Div Neuroradiol, Charleston, SC 29425 USA

来源：

NEUROSURGICAL FOCUS | 2021年 / 51卷 / 01期

关键词：

tandem occlusions; acute ischemic stroke; thrombolysis; carotid atherosclerosis; carotid dissection; thrombectomy; endovascular acute stroke intervention; ARTERY DISSECTION; GUIDELINES; THERAPY;

D O I：

10.3171/2021.4.FOCUS21111

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

OBJECTIVE Different etiologies of extracranial internal carotid artery steno-occlusive lesions (ECLs) in patients with acute ischemic stroke (AIS) and tandem occlusion (TO) have been pooled together in randomized trials. However, carotid atherosclerosis (CA) and carotid dissection (CD), the two most common ECL etiologies, are distinct nosological entities. The authors aimed to determine if ECL etiology has impacts on the endovascular management and outcome of patients with TO. METHODS A multicenter, retrospective study of prospectively collected data was conducted. AIS patients were included who had TO due to internal CA or CD and ipsilateral M, middle cerebral artery occlusion and underwent endovascular treatment (EVT). Comparative analyses including demographic data, safety, successful recanalization rates, and clinical outcome were performed according to EVT and ECL etiology. RESULTS In total, 214 AIS patients with TOs were included (77.6% CA related, 22.4% CD related). Patients treated with a retrograde approach were more often functionally independent at 3 months than patients treated with an antegrade approach (OR 0.6, 95% CI 0.4-0.9). Patients with CD-related TOs achieved 90-day clinical independence more often than patients with CA-related TOs (OR 1.4, 95% CI 1.1-2.0). Emergency stenting use was associated with good 3-month clinical outcome only in patients with CA-related TOs (OR 1.4, 95% CI 1.1-2.1). Symptomatic intracranial hemorrhage (sICH) occurred in 10.7% of patients, without differences associated with ECL etiology. CONCLUSIONS ECL etiology impacts both EVT approach and clinical outcome in patients with TOs. Patients with CD-related TO achieved higher 3-month functional independence rates than patients with CA-related TOs. A retrograde approach can be desirable for both CA- and CD-related TOs, and emergency stenting is likely better justified in CArelated TOs.

引用

页码：1 / 7

页数：7

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