Transcarotid Access for Mechanical Thrombectomy in Acute Ischemic Stroke: A Meta-Analysis and Systematic Review

被引：9

作者：

Zhong, Allison J. ^{[1
]}

Kamal, Haris ^{[2
]}

Uddin, Anaz ^{[1
]}

Feldstein, Eric ^{[2
]}

Shapiro, Steven D. ^{[2
,3
]}

Chung, Joon Yong ^{[1
]}

Ogarro, Maziyah ^{[1
]}

Friedman, Rebecca ^{[1
]}

Simmons, Josh ^{[1
]}

Graifman, Gillian ^{[1
]}

Kurian, Christeena ^{[3
]}

Kaur, Gurmeen ^{[2
,3
]}

Mayer, Stephan A. ^{[2
,3
]}

Chong, Ji ^{[2
,3
]}

Gandhi, Chirag D. ^{[2
,3
]}

Al-Mufti, Fawaz ^{[2
,3
]}

机构：

[1] New York Med Coll, Sch Med, Valhalla, NY 10595 USA

[2] New York Med Coll, Dept Neurosurg, Westchester Med Ctr, 100 Woods Rd, Valhalla, NY 10595 USA

[3] New York Med Coll, Dept Neurol, Westchester Med Ctr, Valhalla, NY 10595 USA

来源：

JOURNAL OF STROKE & CEREBROVASCULAR DISEASES | 2022年 / 31卷 / 05期

关键词：

Cervical; Carotid; Intervention; Technique; Thrombectomy; Stroke; CAROTID-ARTERY PUNCTURE; ENDOVASCULAR TREATMENT; CHALLENGES; TIME;

D O I：

10.1016/j.jstrokecerebrovasdis.2022.106428

中图分类号：

Q189 [神经科学];

学科分类号：

071006 ;

摘要：

Objectives: Despite the success of mechanical thrombectomy in large vessel acute ischemic stroke, recanalization may fail due to difficult anatomic access or peripheral arterial occlusive disease. In these cases, transcarotid access may be used as an alternative, but it has not gained prominence due to safety concerns. Our objective was to assess the efficacy and safety of transcarotid access for mechanical thrombectomy. Materials and Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to perform a systematic review with articles published from 2010 to 2020 summarizing pre-intervention characteristics, techniques utilized, and outcomes of patients undergoing mechanical thrombectomy via trans-carotid puncture. We performed a meta-analysis of clinical outcomes, reperfusion times and overall complications rates of trans-carotid approach. Results: Six studies describing 80 total attempts at carotid access, 72 of which were successful (90% success rate), were included. Direct carotid puncture was most often used as a rescue technique (87% of patients) secondary to failed femoral access. Successful recanalization was achieved in 76% of patients. 90 day modified Rankin Scale < 2 was achieved in 28% of patients. Carotid puncturereperfusion time was 32 min (CI = 24-40, p < 0.001). Cervical complications occurred at a rate of 26.5% (95% CI = 17%-38%). Only 1.3% (1/80 patients) had a fatal outcome and 96% of complications required no intervention. Conclusions: Our results on the safety and efficacy of transcarotid access suggests that this approach is a viable alternative to failed thrombectomy when transfemoral or trans-radial access may be impractical. (c) 2022 Elsevier Inc. All rights reserved.

引用

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