Carotid Artery Stenting and Intracranial Thrombectomy for Tandem Cervical and Intracranial Artery Occlusions

Byungjun Kim, Byung Moon Kim, Oh Young Bang, Jang Hyun Baek, Ji Hoe Heo, Hyo Suk Nam, Young Dae Kim, Joonsang Yoo, Dong Joon Kim, Pyoung Jeon, Seung Kug Baik, Sang Hyun Suh, Kyung Yul Lee, Hyo Sung Kwak, Hong Gee Roh, Young Jun Lee, Sang Heum Kim, Chang Woo Ryu, Yon Kwon Ihn, Hong Jun JeonJin Woo Kim, Jun Soo Byun, Sangil Suh, Jeong Jin Park, Woong Jae Lee, Jieun Roh, Byoung Soo Shin

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

It remains controversial whether carotid artery stenting (CAS) is needed in cases of tandem cervical internal carotid artery occlusion (cICAO) and intracranial large vessel occlusion (LVO). OBJECTIVE: To investigate the efficacy and safety of CAS in combination with endovascular thrombectomy (CAS-EVT) in cICAO-LVO patients and to compare its outcomes with those of EVT without CAS (EVT-alone). METHODS: We identified all patients who underwent EVT for tandem cICAO-LVO from the prospectively maintained registries of 17 stroke centers. Patients were classified into 2 groups: CAS-EVT and EVT-alone. Clinical characteristics and procedural and clinical outcomes were compared between 2 groups. We tested whether CAS-EVT strategy was independently associated with recanalization success. RESULTS: Of the 955 patients who underwent EVT, 75 patients (7.9%) had cICAO-LVO. Fifty-six patients underwent CAS-EVT (74.6%), and the remaining 19 patients underwent EVT-alone (25.4%). The recanalization (94.6% vs 63.2%, P =. 002) and good outcome rates (64.3% vs 26.3%, P =. 007) were significantly higher in the CAS-EVT than in the EVT-alone. Mortality was significantly lower in the CAS-EVT (7.1% vs 21.6%, P =. 014). There was no significant difference in the rate of symptomatic intracranial hemorrhage between 2 groups (10.7 vs 15.8%; P =. 684) and according to the use of glycoprotein IIb/IIIa inhibitor (10.0% vs 12.3%; P =. 999) or antiplatelet medications (10.2% vs 18.8%; P =. 392). CAS-EVT strategy remained independently associated with recanalization success (odds ratio: 24.844; 95% confidence interval: 1.445-427.187). CONCLUSION: CAS-EVT strategy seemed to be effective and safe in cases of tandem cICAO-LVO. CAS-EVT strategy was associated with recanalization success, resulting in better clinical outcome.

Original languageEnglish
Pages (from-to)213-220
Number of pages8
JournalClinical Neurosurgery
Volume86
Issue number2
DOIs
Publication statusPublished - 2020 Feb 1

Keywords

  • Acute stroke
  • Carotid arteries
  • Stent
  • Thrombectomy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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  • Cite this

    Kim, B., Kim, B. M., Bang, O. Y., Baek, J. H., Heo, J. H., Nam, H. S., Kim, Y. D., Yoo, J., Kim, D. J., Jeon, P., Baik, S. K., Suh, S. H., Lee, K. Y., Kwak, H. S., Roh, H. G., Lee, Y. J., Kim, S. H., Ryu, C. W., Ihn, Y. K., ... Shin, B. S. (2020). Carotid Artery Stenting and Intracranial Thrombectomy for Tandem Cervical and Intracranial Artery Occlusions. Clinical Neurosurgery, 86(2), 213-220. https://doi.org/10.1093/neuros/nyz026