Background: The optimal management of patients with acute ischemic stroke (AIS) due to tandem occlusion (TO) and underlying carotid dissection (CD) remains unclear.Objective: We present our multicenter-experience of endovascular treatment (EVT) approach used and outcomes for AIS patients with CD-related TO (CD-TO).Methods: Consecutive AIS patients underwent EVT for CD-TO at five Italian Neuro-interventional Tertiary Stroke Centers were retrospectively identified. TO from atherosclerosis and other causes of, were excluded from the final analysis. Primary outcome was successful (mTICI 2b-3) and complete reperfusion (mTICI 3); secondary outcome was patients' 3-months functional independence (mRS <= 2).Results: Among 214 AIS patients with TO, 45 presented CD-TO. Median age was 54 years (range 29-86), 82.2% were male. Age <65 years (p < 0.0001), lower baseline NIHSS score (p = 0.0002), and complete circle of Willis (p = 0.0422) were associated with mRS <= 2 at the multivariate analysis. Comparisons between antegrade and retrograde approaches resulted in differences for baseline NIHSS scores (p = 0.001) and number of EVT attempts per-procedure (p = 0.001). No differences in terms of recanalization rates were observed between antegrade and retrograde EVT approaches (p = 0.811) but higher rates of mTICI3 revascularization was observed with the retrograde compared to the antegrade approach (78.6% vs 73.3%), anyway not statistically significant. CD management technique (angioplasty vs aspiration vs emergent stenting) did not correlate with 3-months mRS <= 2.Conclusion: AIS patients with CD-TO were mostly treated with the retrograde approach with lower number of attempts perprocedure but it offered similar recanalization rates compared with the antegrade approach. Emergent carotid artery stenting (CAS) proved to be safe for CD management but it does not influence 3-months patients' clinical outcomes.

Da Ros, V., Pusceddu, F., Lattanzi, S., Scaggiante, J., Sallustio, F., Marrama, F., et al. (2022). Endovascular treatment of patients with acute ischemic stroke and tandem occlusion due to internal carotid artery dissection: A multicenter experience. THE NEURORADIOLOGY JOURNAL, 19714009221108673 [10.1177/19714009221108673].

Endovascular treatment of patients with acute ischemic stroke and tandem occlusion due to internal carotid artery dissection: A multicenter experience

Da Ros, Valerio;Di Giuliano, Francesca;Diomedi, Marina;Umana, Giuseppe E;Strigari, Lidia;Garaci, Francesco;Floris, Roberto
2022-06-14

Abstract

Background: The optimal management of patients with acute ischemic stroke (AIS) due to tandem occlusion (TO) and underlying carotid dissection (CD) remains unclear.Objective: We present our multicenter-experience of endovascular treatment (EVT) approach used and outcomes for AIS patients with CD-related TO (CD-TO).Methods: Consecutive AIS patients underwent EVT for CD-TO at five Italian Neuro-interventional Tertiary Stroke Centers were retrospectively identified. TO from atherosclerosis and other causes of, were excluded from the final analysis. Primary outcome was successful (mTICI 2b-3) and complete reperfusion (mTICI 3); secondary outcome was patients' 3-months functional independence (mRS <= 2).Results: Among 214 AIS patients with TO, 45 presented CD-TO. Median age was 54 years (range 29-86), 82.2% were male. Age <65 years (p < 0.0001), lower baseline NIHSS score (p = 0.0002), and complete circle of Willis (p = 0.0422) were associated with mRS <= 2 at the multivariate analysis. Comparisons between antegrade and retrograde approaches resulted in differences for baseline NIHSS scores (p = 0.001) and number of EVT attempts per-procedure (p = 0.001). No differences in terms of recanalization rates were observed between antegrade and retrograde EVT approaches (p = 0.811) but higher rates of mTICI3 revascularization was observed with the retrograde compared to the antegrade approach (78.6% vs 73.3%), anyway not statistically significant. CD management technique (angioplasty vs aspiration vs emergent stenting) did not correlate with 3-months mRS <= 2.Conclusion: AIS patients with CD-TO were mostly treated with the retrograde approach with lower number of attempts perprocedure but it offered similar recanalization rates compared with the antegrade approach. Emergent carotid artery stenting (CAS) proved to be safe for CD management but it does not influence 3-months patients' clinical outcomes.
Online ahead of print
Rilevanza internazionale
Articolo
Esperti anonimi
Settore MED/36
Settore MED/26
English
Endovascular
Internal carotid artery dissection
Interventional
Ischemic stroke
Stroke
Tandem occlusion
Thrombectomy
Da Ros, V., Pusceddu, F., Lattanzi, S., Scaggiante, J., Sallustio, F., Marrama, F., et al. (2022). Endovascular treatment of patients with acute ischemic stroke and tandem occlusion due to internal carotid artery dissection: A multicenter experience. THE NEURORADIOLOGY JOURNAL, 19714009221108673 [10.1177/19714009221108673].
Da Ros, V; Pusceddu, F; Lattanzi, S; Scaggiante, J; Sallustio, F; Marrama, F; Bandettini di Poggio, M; Toscano, G; Di Giuliano, F; Rolla-Bigliani, C; Ruggiero, M; Haznedari, N; Sgreccia, A; Sanfilippo, G; Finocchi, C; Diomedi, M; Tomasi, So; Palmisciano, P; Umana, Ge; Strigari, L; Griessenauer, Cj; Pitocchi, F; Garaci, F; Floris, R
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/309157
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