Emergent Carotid Stenting During Thrombectomy in Tandem Occlusions Secondary to Dissection: A STOP-CAD Secondary Study.
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Sousa João André, Rodrigo-Gisbert Marc, Shu Liqi, Luo Anqi, Xiao Han, Mahmoud Noor A, Shah Asghar, Oliveira Santos Ana Luyza, Moore Marina, Mandel Daniel M, Heldner Mirjam R, Barata Vasco, Bernardo-Castro Sara, Henninger Nils, Muppa Jayachandra, Arnold Marcel, Nehme Ahmad, Rothstein Aaron, Khazaal Ossama, Kaufmann Josefin E, Engelter Stefan T, Traenka Christopher, Metanis Issa, Leker Ronen R, Nolte Christian H, Ghannam Malik, Samaniego Edgar A, Almajali Mohammad, Poppe Alexandre Y, Romoli Michele, Frontera Jennifer, Zedde Marialuisa, Kam Wayneho, Mac Grory Brian, Saleh Velez Faddi, Ranasinghe Tamra, Siegler James E, Zubair Adeel, Marto João Pedro, Klein Piers, Nguyen Thanh N, Abdalkader Mohamad, Mantovani Gabriel, Simpkins Alexis N, Sen Shayak, Elnazeir Marwa, Yaghi Shadi, Sargento-Freitas Joao, Requena Manuel
Аннотация
METHODS: This was a secondary analysis of patients treated with endovascular treatment for acute ischemic stroke due to occlusive carotid artery dissection and tandem occlusion included in the retrospective international STOP-CAD study (Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection). We compared patients with and without emergent stenting. The primary efficacy and safety outcomes were 90-day functional independence (modified Rankin Scale score, 0-2) and symptomatic intracranial hemorrhage within 24 hours after endovascular treatment. Procedural outcome was successful intracranial recanalization (modified Thrombolysis in Cerebral Infarction score of 2b/3). We used mixed-effects logistic regression adjusting for site, age, and National Institutes of Health Stroke Scale. In additional analyses, we used inverse probability of treatment weighting and adjusted for Alberta Stroke Program Early CT Score.
RESULTS: Of the 4023 patients enrolled in STOP-CAD, 328 presented with anterior circulation acute ischemic stroke due to tandem occlusion and underwent endovascular treatment. The median age was 51 (interquartile range, 44-58) years, and 96 patients (29.3%) were female. One hundred fifty patients (45.7%) underwent emergent stenting. There was no significant association between stenting and 90-day functional independence (62.0% versus 59.7%; adjusted odds ratio, 1.23 [95% CI, 0.82-1.86]; P=0.315) or symptomatic intracranial hemorrhage (7.3% versus 7.9%; adjusted odds ratio, 0.95 [95% CI, 0.41-2.2]; P=0.913). Emergent carotid stenting was associated with successful intracranial recanalization (81.8% versus 76.6%; adjusted odds ratio, 2.62 [95% CI, 1.52-4.5]; P<0.001). Results did not meaningfully change in additional analyses.
CONCLUSIONS: In patients presenting with an acute anterior circulation tandem occlusion secondary to cervical carotid artery dissection, emergent stenting was associated with a higher likelihood of successful intracranial recanalization but not improved functional outcomes or increased symptomatic intracranial hemorrhage. It remains unclear whether emergent stenting led to successful intracranial recanalization or patients with successful intracranial recanalization were more likely to be stented. Randomized trials are warranted.