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. 2021 Mar;31(1):21-29.
doi: 10.1007/s00062-020-00980-5. Epub 2020 Dec 10.

Mechanical Thrombectomy for Acute Intracranial Carotid Occlusion with Patent Intracranial Arteries : The Italian Registry of Endovascular Treatment in Acute Stroke

Fabrizio Sallustio  1   2 , Valentina Saia  3 , Federico Marrama  4 , Giovanni Pracucci  5 , Roberto Gandini  6 , Giacomo Koch  4   7 , Alfredo Paolo Mascolo  4 , Federica D'Agostino  4 , Alessandro Rocco  4 , Renato Argiro'  6 , Marco Nezzo  6 , Daniele Morosetti  6 , Andrea Wlderk  6 , Valerio Da Ros  6 , Marina Diomedi  4 , Leonardo Renieri  8 , Patrizia Nencini  5 , Stefano Vallone  9 , Andrea Zini  10 , Guido Bigliardi  9 , Antonio Caragliano  11 , Isabella Francalanza  12 , Sandra Bracco  13 , Rossana Tassi  14 , Mauro Bergui  15 , Andrea Naldi  16 , Andrea Saletti  17 , Alessandro De Vito  18 , Roberto Gasparotti  19 , Mauro Magoni  20 , Luigi Cirillo  21 , Christian Commodaro  22 , Sara Biguzzi  23 , Lucio Castellan  24 , Laura Malfatto  25 , Roberto Menozzi  26 , Ilaria Grisendi  27 , Mirco Cosottini  28 , Giovanni Orlandi  29 , Alessio Comai  30 , Enrica Franchini  31 , Francesco D'Argento  32 , Giovanni Frisullo  33 , Edoardo Puglielli  34 , Alfonsina Casalena  35 , Francesco Causin  36 , Claudio Baracchini  37 , Andrea Boghi  38 , Gigliola Chianale  39 , Raffaele Augelli  40 , Manuel Cappellari  41 , Luigi Chiumarulo  42 , Marco Petruzzellis  43 , Alessandro Sgreccia  44 , Piera Tosi  45 , Nicola Cavasin  46 , Adriana Critelli  47 , Vittorio Semeraro  48 , Giovanni Boero  49 , Francesco Vizzari  50 , Lucia Princiotta Cariddi  51 , Olindo Di Benedetto  52 , Pierfrancesco Pugliese  53 , Marta Iacobucci  54 , Manuela De Michele  55 , Federico Fusaro  56 , Jessica Moller  57 , Luca Allegretti  58 , Tiziana Tassinari  3 , Nunzio Paolo Nuzzi  59 , Simona Marcheselli  60 , Simona Sacco  61 , Marco Pavia  62 , Paolo Invernizzi  63 , Ivan Gallesio  64 , Luigi Ruiz  65 , Sandro Zedda  66 , Rosario Rossi  67 , Pietro Amistà  68 , Monia Russo  69 , Francesco Pintus  70 , Alessandra Sanna  71 , Giuseppe Craparo  72 , Marina Mannino  73 , Domenico Inzitari  5 , Salvatore Mangiafico  8 , Danilo Toni  55 ; Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) Collaborators
Affiliations

Mechanical Thrombectomy for Acute Intracranial Carotid Occlusion with Patent Intracranial Arteries : The Italian Registry of Endovascular Treatment in Acute Stroke

Fabrizio Sallustio et al. Clin Neuroradiol. 2021 Mar.

Abstract

Purpose: Intracranial carotid artery occlusion represents an underinvestigated cause of acute ischemic stroke as well as an indication for mechanical thrombectomy. We investigated baseline and procedural characteristics, outcomes and predictors of outcome in patients with acute ischemic stroke secondary to intracranial carotid artery occlusion.

Methods: A retrospective analysis of the Italian Registry of Endovascular Treatment in Acute Stroke was performed. Patients with intracranial carotid artery occlusion (infraclinoid and supraclinoid) with or without cervical artery occlusion but with patent intracranial arteries were included. The 3‑month functional independence, mortality, successful reperfusion and symptomatic intracranial hemorrhage were evaluated.

Results: Intracranial carotid artery occlusion with patent intracranial arteries was diagnosed in 387 out of 4940 (7.8%) patients. The median age was 74 years and median baseline National Institute of Health Stroke Scale (NIHSS) was 18. Functional independence was achieved in 130 (34%) patients, successful reperfusion in 289 (75%) and symptomatic intracranial hemorrhage in 33 (9%), whereas mortality occurred in 111 (29%) patients. In univariate analysis functional independence was associated with lower age, lower NIHSS at presentation, higher rate of successful reperfusion and lower rate of symptomatic intracranial hemorrhage. Multivariable regression analysis found age (odds ratio, OR:1.03; P = 0.006), NIHSS at presentation (OR: 1.07; P < 0.001), diabetes (OR: 2.60; P = 0.002), successful reperfusion (OR:0.20; P < 0.001) and symptomatic intracranial hemorrhage (OR: 4.17; P < 0.001) as the best independent predictors of outcome.

Conclusion: Our study showed a not negligible rate of intracranial carotid artery occlusion with patent intracranial arteries, presenting mostly as severe stroke, with an acceptable rate of 3‑month functional independence. Age, NIHSS at presentation and successful reperfusion were the best independent predictors of outcome.

Keywords: Circle of Willis; Endovascular treatment; Large vessel occlusion; Outcome; Stroke severity.

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