Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2015 Dec;36(12):2340-5.
doi: 10.3174/ajnr.A4459. Epub 2015 Aug 20.

Emergency Stenting of the Extracranial Internal Carotid Artery in Combination with Anterior Circulation Thrombectomy in Acute Ischemic Stroke: A Retrospective Multicenter Study

D Behme  1 , A Mpotsaris  2 , P Zeyen  2 , M N Psychogios  3 , A Kowoll  4 , C J Maurer  5 , F Joachimski  6 , J Liman  7 , K Wasser  7 , C Kabbasch  2 , A Berlis  5 , M Knauth  3 , T Liebig  2 , W Weber  4
Affiliations
Multicenter Study

Emergency Stenting of the Extracranial Internal Carotid Artery in Combination with Anterior Circulation Thrombectomy in Acute Ischemic Stroke: A Retrospective Multicenter Study

D Behme et al. AJNR Am J Neuroradiol. 2015 Dec.

Abstract

Background and purpose: Several small case series reported a favorable clinical outcome for emergency stent placement in the extracranial internal carotid artery combined with mechanical thrombectomy in acute stroke. The rate of postinterventional symptomatic intracranial hemorrhages was reported to be as high as 20%. Therefore, we investigated the safety and efficacy of this technique in a large multicentric cohort.

Materials and methods: The data bases of 4 German stroke centers were screened for all patients who received emergency stent placement of the extracranial internal carotid artery in combination with mechanical thrombectomy of the anterior circulation between 2007 and 2014. The primary outcome measure was the rate of symptomatic intracranial hemorrhage according to the European Cooperative Acute Stroke Study III criteria; secondary outcome measures included the angiographic revascularization results and clinical outcome.

Results: One hundred seventy patients with a median age of 64 years (range, 25-88 years) were treated. They presented after a median of 98 minutes (range, 52-160 minutes) with a median NIHSS score of 15 (range, 12-19). Symptomatic intracranial hemorrhages occurred in 15/170 (9%) patients; there was no statistically significant difference among groups pertaining to age, sex, intravenous rtPA, procedural timings, and the rate of successful recanalization. In 130/170 (77%) patients, a TICI score of ≥ 2b could be achieved. The in-hospital mortality rate was 19%, and 36% of patients had a favorable outcome at follow-up.

Conclusions: Emergency stent placement in the extracranial internal carotid artery in combination with anterior circulation thrombectomy is effective and safe. It is not associated with a significantly higher risk of symptomatic intracranial hemorrhage compared with published series for mechanical thrombectomy alone.

PubMed Disclaimer

References

    1. Grau AJ, Weimar C, Buggle F, et al. . Risk factors, outcome, and treatment in subtypes of ischemic stroke: the German stroke data bank. Stroke 2001;32:2559–66 10.1161/hs1101.098524 - DOI - PubMed
    1. Rubiera M, Ribo M, Delgado-Mederos R, et al. . Tandem internal carotid artery/middle cerebral artery occlusion: an independent predictor of poor outcome after systemic thrombolysis. Stroke 2006;37:2301–05 10.1161/01.STR.0000237070.80133.1d - DOI - PubMed
    1. Kim YS, Garami Z, Mikulik R, et al. ; CLOTBUST Collaborators. Early recanalization rates and clinical outcomes in patients with tandem internal carotid artery/middle cerebral artery occlusion and isolated middle cerebral artery occlusion. Stroke 2005;36:869–71 10.1161/01.STR.0000160007.57787.4c - DOI - PubMed
    1. Mpotsaris A, Bussmeyer M, Buchner H, et al. . Clinical outcome of neurointerventional emergency treatment of extra- or intracranial tandem occlusions in acute major stroke: antegrade approach with Wallstent and Solitaire stent retriever. Clin Neuroradiol 2013;23:207–15 10.1007/s00062-013-0197-y - DOI - PubMed
    1. Lockau H, Liebig T, Henning T, et al. . Mechanical thrombectomy in tandem occlusion: procedural considerations and clinical results. Neuroradiology 2015;57:589–98 10.1007/s00234-014-1465-5 - DOI - PubMed

Publication types

MeSH terms