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

Cosottini, Mirco;Orlandi, Giovanni;
2023-01-01

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.
2023
Sallustio, Fabrizio; Pracucci, Giovanni; Cappellari, Manuel; Saia, Valentina; Mascolo, Alfredo Paolo; Marrama, Federico; Gandini, Roberto; Koch, Giacomo; Diomedi, Marina; D'Agostino, Federica; Rocco, Alessandro; Da Ros, Valerio; Wlderk, Andrea; Nezzo, Marco; Argirò, Renato; Morosetti, Daniele; Renieri, Leonardo; Nencini, Patrizia; Vallone, Stefano; Zini, Andrea; Bigliardi, Guido; Pitrone, Antonio; Grillo, Francesco; Bracco, Sandra; Tassi, Rossana; Bergui, Mauro; Naldi, Andrea; Carità, Giuseppe; Casetta, Ilaria; Gasparotti, Roberto; Magoni, Mauro; Simonetti, Luigi; Haznedari, Nicolò; Paolucci, Matteo; Mavilio, Nicola; Malfatto, Laura; Menozzi, Roberto; Genovese, Antonio; Cosottini, Mirco; Orlandi, Giovanni; Comai, Alessio; Franchini, Enrica; Pedicelli, Alessandro; Frisullo, Giovanni; Puglielli, Edoardo; Casalena, Alfonsina; Cester, Giacomo; Baracchini, Claudio; Castellano, Davide; Di Liberto, Alessandra; Ricciardi, Giuseppe Kenneth; Chiumarulo, Luigi; Petruzzellis, Marco; Lafe, Elvis; Persico, Alessandra; Cavasin, Nicola; Critelli, Adriana; Semeraro, Vittorio; Tinelli, Angelica; Giorgianni, Andrea; Carimati, Federico; Auteri, William; Rizzuto, Stefano; Biraschi, Francesco; Nicolini, Ettore; Ferrari, Antonio; Melis, Maurizio; Calia, Stefano; Tassinari, Tiziana; Nuzzi, Nunzio Paolo; Corato, Manuel; Sacco, Simona; Squassina, Guido; Invernizzi, Paolo; Gallesio, Ivan; Ruiz, Luigi; Dui, Giovanni; Carboni, Nicola; Amistà, Pietro; Russo, Monia; Maiore, Mario; Zanda, Bastianina; Craparo, Giuseppe; Mannino, Marina; Inzitari, Domenico; Toni, Danilo; Mangiafico, Salvatore
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11568/1185088
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