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
. 2023 Apr;123(2):475-485.
doi: 10.1007/s13760-022-02067-z. Epub 2022 Sep 2.

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

Fabrizio Sallustio  1   2 , Giovanni Pracucci  3 , Manuel Cappellari  4 , Valentina Saia  5 , Alfredo Paolo Mascolo  6 , Federico Marrama  6 , Roberto Gandini  7 , Giacomo Koch  6   8 , Marina Diomedi  6 , Federica D'Agostino  6 , Alessandro Rocco  6 , Valerio Da Ros  7 , Andrea Wlderk  7 , Marco Nezzo  7 , Renato Argirò  7 , Daniele Morosetti  7 , Leonardo Renieri  9 , Patrizia Nencini  3 , Stefano Vallone  10 , Andrea Zini  11 , Guido Bigliardi  12 , Antonio Pitrone  13 , Francesco Grillo  14 , Sandra Bracco  15 , Rossana Tassi  16 , Mauro Bergui  17 , Andrea Naldi  18 , Giuseppe Carità  19 , Ilaria Casetta  20 , Roberto Gasparotti  21 , Mauro Magoni  22 , Luigi Simonetti  23 , Nicolò Haznedari  24 , Matteo Paolucci  25 , Nicola Mavilio  26 , Laura Malfatto  27 , Roberto Menozzi  28 , Antonio Genovese  29 , Mirco Cosottini  30 , Giovanni Orlandi  31 , Alessio Comai  32 , Enrica Franchini  33 , Alessandro Pedicelli  34 , Giovanni Frisullo  35 , Edoardo Puglielli  36 , Alfonsina Casalena  37 , Giacomo Cester  38 , Claudio Baracchini  39 , Davide Castellano  40 , Alessandra Di Liberto  41 , Giuseppe Kenneth Ricciardi  42 , Luigi Chiumarulo  43 , Marco Petruzzellis  44 , Elvis Lafe  45 , Alessandra Persico  46 , Nicola Cavasin  47 , Adriana Critelli  48 , Vittorio Semeraro  49 , Angelica Tinelli  50 , Andrea Giorgianni  51 , Federico Carimati  52 , William Auteri  53 , Stefano Rizzuto  54 , Francesco Biraschi  55 , Ettore Nicolini  56 , Antonio Ferrari  57 , Maurizio Melis  58 , Stefano Calia  59 , Tiziana Tassinari  5 , Nunzio Paolo Nuzzi  60 , Manuel Corato  61 , Simona Sacco  62 , Guido Squassina  63 , Paolo Invernizzi  64 , Ivan Gallesio  65 , Luigi Ruiz  66 , Giovanni Dui  67 , Nicola Carboni  68 , Pietro Amistà  69 , Monia Russo  70 , Mario Maiore  71 , Bastianina Zanda  72 , Giuseppe Craparo  73 , Marina Mannino  74 , Domenico Inzitari  3 , Danilo Toni  56 , Salvatore Mangiafico  9 ; Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) Collaborators
Collaborators, Affiliations

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

Fabrizio Sallustio et al. Acta Neurol Belg. 2023 Apr.

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-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.

Keywords: Acute stroke; Internal carotid artery diseases; Stent; Thrombectomy.

PubMed Disclaimer

References

    1. Saver JL, Goyal M, Bonafe A, SWIFT PRIME Investigators et al (2015) Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 372:2285–2295. https://doi.org/10.1056/NEJMoa1415061 - DOI - PubMed
    1. Berkhemer OA, Fransen PS, Beumer D, MR CLEAN Investigators et al (2015) A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 372:11–20. https://doi.org/10.1056/NEJMoa1411587 - DOI - PubMed
    1. Goyal M, Menon BK, van Zwam WH, HERMES collaborators et al (2016) Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 387:1723–1731. https://doi.org/10.1016/S0140-6736(16)00163-X - DOI - PubMed
    1. Rubiera M, Ribo M, Delgado-Mederos R et al (2006) Tandem internal carotid artery/middle cerebral artery occlusion: an independent predictor of poor outcome after systemic thrombolysis. Stroke 37:2301–2305. https://doi.org/10.1161/01.STR.0000237070.80133.1d - DOI - PubMed
    1. Sallustio F, Motta C, Koch G et al (2017) Endovascular stroke treatment of acute tandem occlusion: a single-center experience. J Vasc Interv Radiol 28:543–549. https://doi.org/10.1016/j.jvir.2017.01.007 - DOI - PubMed

LinkOut - more resources