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, AP; 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; Bigliardi, G; Pitrone, A; Grillo, F; Bracco, S; Tassi, R; Bergui, M; Naldi, A; Carita, G; Casetta, I; Gasparotti, R; Magoni, M; Simonetti, L; Haznedari, N; Paolucci, M; Mavilio, N; Malfatto, L; Menozzi, R; Genovese, A; Cosottini, M; Orlandi, G; Comai, A; Franchini, E; Pedicelli, A; Frisullo, G; Puglielli, E; Casalena, A; Cester, G; Baracchini, C; Castellano, D; Di Liberto, A; Ricciardi, GK; Chiumarulo, L; Petruzzellis, M; Lafe, E; Persico, A; Cavasin, N; Critelli, A; Semeraro, V; Tinelli, A; Giorgianni, A; Carimati, F; Auteri, W; Rizzuto, S; Biraschi, F; Nicolini, E; Ferrari, A; Melis, M; Calia, S; Tassinari, T; Nuzzi, NP; Corato, M; Sacco, S; Squassina, G; Invernizzi, P; Gallesio, I; Ruiz, L; Dui, G; Carboni, N; Amista, P; Russo, M; Maiore, M; Zanda, B; Craparo, G; Mannino, M; Inzitari, D; Toni, D; Mangiafico, S. - In: ACTA NEUROLOGICA BELGICA. - ISSN 0300-9009. - ELETTRONICO. - (2022), pp. 1-11. [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

Pracucci, G;Nencini, P;Inzitari, D;Mangiafico, S
2022

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.
2022
1
11
Sallustio, F; Pracucci, G; Cappellari, M; Saia, V; Mascolo, AP; 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; Bigliardi, G; Pitrone, A; Grillo, F; Bracco, S; Tassi, R; Bergui, M; Naldi, A; Carita, G; Casetta, I; Gasparotti, R; Magoni, M; Simonetti, L; Haznedari, N; Paolucci, M; Mavilio, N; Malfatto, L; Menozzi, R; Genovese, A; Cosottini, M; Orlandi, G; Comai, A; Franchini, E; Pedicelli, A; Frisullo, G; Puglielli, E; Casalena, A; Cester, G; Baracchini, C; Castellano, D; Di Liberto, A; Ricciardi, GK; Chiumarulo, L; Petruzzellis, M; Lafe, E; Persico, A; Cavasin, N; Critelli, A; Semeraro, V; Tinelli, A; Giorgianni, A; Carimati, F; Auteri, W; Rizzuto, S; Biraschi, F; Nicolini, E; Ferrari, A; Melis, M; Calia, S; Tassinari, T; Nuzzi, NP; Corato, M; Sacco, S; Squassina, G; Invernizzi, P; Gallesio, I; Ruiz, L; Dui, G; Carboni, N; Amista, P; Russo, M; Maiore, M; Zanda, B; Craparo, G; Mannino, M; Inzitari, D; Toni, D; Mangiafico, S
File in questo prodotto:
File Dimensione Formato  
Acta Neurol Belg 2022_on-line first.pdf

Accesso chiuso

Tipologia: Pdf editoriale (Version of record)
Licenza: DRM non definito
Dimensione 629.21 kB
Formato Adobe PDF
629.21 kB Adobe PDF   Richiedi una copia

I documenti in FLORE sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/1285720
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus 1
  • ???jsp.display-item.citation.isi??? 1
social impact