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

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.

Carotid Artery Stenosis Contralateral to Acute Tandem Occlusion: An Independent Predictor of Poor Clinical Outcome after Mechanical Thrombectomy with Concomitant Carotid Artery Stenting

“…According to the guidelines of the respective local Ethics Committees, no approval was necessary for this anonymous retrospective analysis, which was conducted in accordance to the Declaration of Helsinki. Clinical results of some of the patients have been published in previous studies [7, 14, 16, 27] in a different context.…”

“…Inclusion was evidence of a TO in the anterior circulation identified on CT angiography (CTA). All patients were included independent of the administered antiplatelet regime that differed between the centers [7]. There were no general limitations on baseline variables such as age and National Institutes of Health Stroke Scale (NIHSS) on admission or procedural characteristics including the use of different stents and choice of antegrade (extracranial stenting, then MT) or retrograde (MT, then extracranial stenting) treatment order, which was left to the attending neuroradiologist’s discretion.…”

“…Data about the use of stent-retriever-based mechanical thrombectomy (MT) in this patient cohort with concomitant stenting of the carotid artery lesion remain limited due to underrepresentation of this patient group in randomized clinical stroke trials [4-6]. Recently published retrospective case series at least suggest technical feasibility and safety of endovascular treatment of TO [7-22]. …”

European Recommendations on Organisation of Interventional Care in Acute Stroke (EROICAS)

“…Recently published cohort studies indicate that tandem stenosis/occlusions of the ICA/MCA can be treated with acute stenting of the extracranial internal carotid and stent-retriever mechanical thrombectomy in the MCA with a reasonable risk profile. (36)(37)(38)(39)(40)(41)(42)(43)(44) Acute stenting of occlusions of the extracranial ICA resulted in a higher recanalization rate (87% vs 48%, p=0.001) and favorable outcomes (68% vs 15%, p<0.001) as well as lower mortality (18% vs 41%, p=0.048) when compared to intra-arterial thrombolysis. (39) Longer clot length as measured on thin-section NCCT has been associated in several studies with low probability of successful recanalization with IV tPA (45)(46)(47), raising the possibility that this group might derive greater benefit from EVT.…”

Endovascular treatment of ischaemic stroke patients - new evidence and old challenges

“…Immediate stent placement in the ICA necessitates subsequent platelet inhibition, adding to the already increased risk of cerebral haemorrhage in stroke patients. In retrospective studies, emergency recanalisation and stent placement in the extracranial ICA in combination with anterior circulation thrombectomy was eff ective [64,65] and safe [65]. Prospective studies are missing.…”