Purpose: The management of tandem extracranial internal carotid artery and intracranial large vessel occlusion during endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) has been under-investigated. We sought to investigate outcomes of AIS patients with tandem occlusion (TO) treated with carotid artery stenting (CAS) compared to those not treated with CAS (no-CAS) during EVT. Methods: We performed a cohort study using data from AIS patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. Outcomes were 3 months’ mortality, functional outcome, complete and successful recanalization, any intracranial hemorrhage, parenchymal hematoma and symptomatic intracerebral hemorrhage. Results: Among 466 AIS patients with TO, CAS patients were 122 and no-CAS patients were 226 (118 excluded). After adjustment for unbalanced variables, CAS was associated with a lower rate of 3 months’ mortality (OR 0.407, 95% CI 0.171–0.969, p = 0.042). After adjustment for pre-d...

Purpose: The management of tandem extracranial internal carotid artery and intracranial large vessel occlusion during endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) has been under-investigated. We sought to investigate outcomes of AIS patients with tandem occlusion (TO) treated with carotid artery stenting (CAS) compared to those not treated with CAS (no-CAS) during EVT. Methods: We performed a cohort study using data from AIS patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. Outcomes were 3 months’ mortality, functional outcome, complete and successful recanalization, any intracranial hemorrhage, parenchymal hematoma and symptomatic intracerebral hemorrhage. Results: Among 466 AIS patients with TO, CAS patients were 122 and no-CAS patients were 226 (118 excluded). After adjustment for unbalanced variables, CAS was associated with a lower rate of 3 months’ mortality (OR 0.407, 95% CI 0.171–0.969, p = 0.042). After adjustment for pre-defined variables, CAS was associated with a lower rate of 3 months’ mortality (aOR 0.430, 95% CI 0.187–0.989, p = 0.047) and a higher rate of complete recanalization (aOR 1.986, 95% CI 1.121–3.518, p = 0.019), successful recanalization (aOR 2.433, 95% CI 1.263–4.686, p = 0.008) and parenchymal hematoma (aOR 2.876, 95% CI 1.173–7.050, p = 0.021). CAS was associated with lower 3 months mortality (OR 0.373, 95% CI 0.141–0.982, p = 0.046) and higher rates of successful recanalization (OR 2.082, 95% CI 1.099–3.942, p = 0.024) after adjustment for variables associated with 3 months’ mortality and successful recanalization, respectively. Conclusions: Among AIS patients with TO, CAS during EVT was associated with a higher rate of successful reperfusion and a lower rate of 3 months’ mortality.

Carotid artery stenting during endovascular thrombectomy for acute ischemic stroke with tandem occlusion: the Italian Registry of Endovascular Treatment in Acute Stroke / Sallustio, F., Pracucci, G., Cappellari, M., Saia, V., Mascolo, A.P., Marrama, F., Gandini, R., Koch, G., Diomedi, M., D'Agostino, F., Rocco, A., Da Ros, V., Wlderk, A., Nezzo, M., Argiro, R., Morosetti, D., Renieri, L., Nencini, P., Vallone, S., Zini, A., et al.. - In: ACTA NEUROLOGICA BELGICA. - ISSN 0300-9009. - 123:2(2023), pp. 475-485. [10.1007/s13760-022-02067-z]

Carotid artery stenting during endovascular thrombectomy for acute ischemic stroke with tandem occlusion: the Italian Registry of Endovascular Treatment in Acute Stroke

Comai A.;Comai A.;Feraco P.;Giometto B.;
2023-01-01

Abstract

Purpose: The management of tandem extracranial internal carotid artery and intracranial large vessel occlusion during endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) has been under-investigated. We sought to investigate outcomes of AIS patients with tandem occlusion (TO) treated with carotid artery stenting (CAS) compared to those not treated with CAS (no-CAS) during EVT. Methods: We performed a cohort study using data from AIS patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. Outcomes were 3 months’ mortality, functional outcome, complete and successful recanalization, any intracranial hemorrhage, parenchymal hematoma and symptomatic intracerebral hemorrhage. Results: Among 466 AIS patients with TO, CAS patients were 122 and no-CAS patients were 226 (118 excluded). After adjustment for unbalanced variables, CAS was associated with a lower rate of 3 months’ mortality (OR 0.407, 95% CI 0.171–0.969, p = 0.042). After adjustment for pre-d...
2023
2
Sallustio, F.; Pracucci, G.; Cappellari, M.; Saia, V.; Mascolo, A. P.; Marrama, F.; Gandini, R.; Koch, G.; Diomedi, M.; D'Agostino, F.; Rocco, A.; Da ...espandi
Carotid artery stenting during endovascular thrombectomy for acute ischemic stroke with tandem occlusion: the Italian Registry of Endovascular Treatment in Acute Stroke / Sallustio, F., Pracucci, G., Cappellari, M., Saia, V., Mascolo, A.P., Marrama, F., Gandini, R., Koch, G., Diomedi, M., D'Agostino, F., Rocco, A., Da Ros, V., Wlderk, A., Nezzo, M., Argiro, R., Morosetti, D., Renieri, L., Nencini, P., Vallone, S., Zini, A., et al.. - In: ACTA NEUROLOGICA BELGICA. - ISSN 0300-9009. - 123:2(2023), pp. 475-485. [10.1007/s13760-022-02067-z]
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