Overview of Evidence on Emergency Carotid Stenting in Acute Ischemic Stroke due to Tandem Occlusions: A Systematic Review and Meta-Analysis

Coelho, Andreia; Lobo, Miguel; Gouveia, Ricardo; Augusto, Rita; Coelho, Nuno; Semião, Ana Carolina; Silveira, Diogo; Canedo, Alexandra

doi:10.1016/j.ejvs.2019.06.515

Cited by 3 publications

(3 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The comparison of elective results to emergency CAS interventions in acute stroke shows significantly higher complication rates and worse clinical treatment results. With a stent thrombosis rate of 10.1 % and symptomatic bleeding in 7.6 % of cases, our results regarding the most important CAS-associated complications are in the range of published data from other studies 30 31 32 33 34 35 36 37 . Thus, relatively aggressive and systematic platelet aggregation inhibition did not result in a clear increase in bleeding rate.…”

Section: Discussionsupporting

confidence: 70%

See 1 more Smart Citation

Elective carotid stenting fulfills quality standards defined in guidelines

Keil,

Stahn,

Reitz

et al. 2023

Rofo

View full text Add to dashboard Cite

Purpose According to evidence from randomized trials and current guidelines, elective carotid artery stenting (CAS) is still considered second-line therapy compared with carotid endarterectomy (CEA). However, the publication of randomized comparative trials for patients with symptomatic stenoses occurred well over 10 years ago. In view of problems regarding German quality assurance when differentiating elective from emergency interventions and low case numbers for CAS indications, it seemed reasonable to present neurologically controlled CAS results and to investigate whether elective CAS consistently fulfills the strict quality criteria and what differences exist with respect to emergency CAS interventions in acute ischemic stroke. Materials and Methods Between 01/2012 and 07/2022, 141 elective CAS procedures were performed to treat patients with symptomatic (n = 123) and asymptomatic (n = 18) stenoses. Protection by a filter system was achieved in 134 of these elective procedures (95 %). During the same period, 158 patients underwent carotid stenting for acute stroke. Complication rates were determined using neurologically controlled data. CAS-related complications (stent thrombosis, stent-associated vascular damage, thromboembolism, and symptomatic hemorrhage) were extracted from emergency interventions, and clinical outcome (NIHSS progression) was determined during the inpatient stay. Results The rate of stroke and death determined during the inpatient stay for elective symptomatic patients was 0.8 %. Early treatment within the first 7 days after the index event, age > 70 years, and operator experience were not significant risk factors for the occurrence of complications. No complications were observed after CAS of asymptomatic stenoses. The procedure-related complication rate for emergency procedures was 7.8 %, which was significantly higher than after elective CAS, as expected (p < 0.006). Conclusion Even with limited indications and limited case numbers, compliance with the strict quality criteria of the current S3 Guideline 2022 for elective CAS interventions is possible for both symptomatic and asymptomatic stenoses in an experienced center. Emergency CAS interventions have significantly higher complication rates under other conditions and must be considered separately with regard to quality assurance. Key Points: Citation Format

show abstract

Section: Discussionsupporting

confidence: 70%

“…Mit einer Stent-Thrombose-Rate von 10,1 % und sympt. Blutungen in 7,6 % der Fälle liegen die eigenen Ergebnisse für die wichtigsten CAS-assoziierten Komplikationen im Bereich publizierter Daten aus anderen Studien 30 31 32 33 34 35 36 37 . So führte die relativ aggressive und konsequente TAH nicht zu einer klar erhöhten Blutungsrate.…”

Section: Diskussionunclassified

Elective carotid stenting fulfills quality standards defined in guidelines

Keil,

Stahn,

Reitz

et al. 2023

Rofo

View full text Add to dashboard Cite

show abstract

“…1,2 The optimal endovascular approach for treating the proximal cervical lesion has not been definitively established in current guidelines. However, a significant body of evidence from large multicenter international registries [2][3][4][5][6] and large meta-analyses [7][8][9] strongly suggests that acute carotid artery stenting (CAS) of the cervical lesion during endovascular therapy (EVT) is associated with better neurologic recovery. To date, ongoing randomized trials such as the Thrombectomy in Tandem Lesion (TITAN; NCT03978988) and Endovascular Acute Stroke Intervention-Tandem Occlusion Trial (EASI-TOC; NCT04261478) are actively investigating the safety and efficacy of acute CAS in the setting of TLs.…”

Section: Introductionmentioning

confidence: 99%

Mediation Analysis of Acute Carotid Stenting in Tandem Lesions

Rodriguez Calienes,

Galecio-Castillo,

Petersen

et al. 2024

Neurology

View full text Add to dashboard Cite

Background and ObjectivesCurrent evidence suggests that acute carotid artery stenting (CAS) for cervical lesions is associated with better functional outcomes in patients with acute stroke with tandem lesions (TLs) treated with endovascular therapy (EVT). However, the underlying causal pathophysiologic mechanism of this relationship compared with a non-CAS strategy remains unclear. We aimed to determine whether, and to what degree, reperfusion mediates the relationship between acute CAS and functional outcome in patients with TLs.

show abstract

Commentary on Optimal Treatment Strategy for Tandem Stroke

Meyers¹,

Higashida²

2018

JACC: Cardiovascular Interventions

View full text Add to dashboard Cite

Overview of Evidence on Emergency Carotid Stenting in Acute Ischemic Stroke due to Tandem Occlusions: A Systematic Review and Meta-Analysis

Cited by 3 publications

References 0 publications

Elective carotid stenting fulfills quality standards defined in guidelines

Elective carotid stenting fulfills quality standards defined in guidelines

Mediation Analysis of Acute Carotid Stenting in Tandem Lesions

Commentary on Optimal Treatment Strategy for Tandem Stroke

Contact Info

Product

Resources

About