AJNR. American journal of neuroradiology · 2026
Emergent Carotid Angioplasty or Stenting for Internal Carotid-Middle Cerebral Artery Tandem Occlusion Strokes: Real-World Outcomes in a Nationwide Cohort.
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Chen Huanwen, McIntyre Matthew K, Lakhani Dhairya A, Malhotra Ajay, Colasurdo Marco, Gandhi Dheeraj
Аннотация
BACKGROUND AND PURPOSE: While endovascular thrombectomy (EVT) of intracranial occlusions is currently guideline-recommended, whether additional emergent balloon angioplasty (BA) or carotid artery stent placement (CAS) is effective and safe for patients with internal carotid-middle cerebral artery tandem occlusion (TO) is less clear. This study evaluated the outcomes following EVT combined with BA versus CAS alone for patients with TO.
MATERIALS AND METHODS: This was a retrospective cohort study of the Nationwide Readmissions database (2016-2022). Patients with ipsilateral ICA-MCA TO treated with EVT were identified, and stratified into 3 groups: EVT alone, EVT + BA, and EVT + CAS. The primary end point was the patient's functional status at the time of hospital discharge as an ordinal variable, ranging from functional independence to death. Secondary outcomes included in-hospital mortality and intracranial hemorrhage (ICH). Multivariable regression analyses adjusting for patient demographics, stroke severity, and comorbidities were used to account for confounding bias.
RESULTS: A total of 4928 patients were identified, of whom 3371 (68.4%) received EVT alone; 541 (11.0%), EVT + BA; and 1015 (20.6%), EVT + CAS. Compared with EVT alone, EVT + BA was not associated with significant differences in functional outcomes, mortality, or ICH (all adjusted P value > .05), whereas EVT + CAS was associated with improved functional status (adjusted common OR, 1.27 [95% CI, 1.04-1.55], P = .02) and mortality (11.2% versus 21.6%; adjusted OR, 0.62 [95% CI, 0.47-0.82], P < .001), without significantly increased ICH (37.5% versus 34.4%; adjusted OR, 1.27 [95% CI, 0.99-1.64], P = .06).
CONCLUSIONS: Emergent EVT + CAS for patients with TO was associated with improved functional outcomes and reduced in-hospital mortality without significantly increasing the ICH risk.
MATERIALS AND METHODS: This was a retrospective cohort study of the Nationwide Readmissions database (2016-2022). Patients with ipsilateral ICA-MCA TO treated with EVT were identified, and stratified into 3 groups: EVT alone, EVT + BA, and EVT + CAS. The primary end point was the patient's functional status at the time of hospital discharge as an ordinal variable, ranging from functional independence to death. Secondary outcomes included in-hospital mortality and intracranial hemorrhage (ICH). Multivariable regression analyses adjusting for patient demographics, stroke severity, and comorbidities were used to account for confounding bias.
RESULTS: A total of 4928 patients were identified, of whom 3371 (68.4%) received EVT alone; 541 (11.0%), EVT + BA; and 1015 (20.6%), EVT + CAS. Compared with EVT alone, EVT + BA was not associated with significant differences in functional outcomes, mortality, or ICH (all adjusted P value > .05), whereas EVT + CAS was associated with improved functional status (adjusted common OR, 1.27 [95% CI, 1.04-1.55], P = .02) and mortality (11.2% versus 21.6%; adjusted OR, 0.62 [95% CI, 0.47-0.82], P < .001), without significantly increased ICH (37.5% versus 34.4%; adjusted OR, 1.27 [95% CI, 0.99-1.64], P = .06).
CONCLUSIONS: Emergent EVT + CAS for patients with TO was associated with improved functional outcomes and reduced in-hospital mortality without significantly increasing the ICH risk.