Guillaume Perrin , Elisabeth Molinier , Benjamin Gory , Maeva Kyheng , Julien Labreuche , Marco Pasi , Kevin Janot , Romain Bourcier , Igor Sibon , Arturo Consoli , Jean-Philippe Desilles , Jean-Marc Olivot , Chrysanthi Papagiannaki , Sebastien Soize , Jean-Christophe Gentric , Cyril Dargazanli , Jildaz Caroff , Raoul Pop , Olivier Naggara , Solene Moulin , Gaultier Marnat
{"title":"采用机械血栓切除术治疗夹层相关串联闭塞症时,第 1 天颈动脉通畅对疗效的影响","authors":"Guillaume Perrin , Elisabeth Molinier , Benjamin Gory , Maeva Kyheng , Julien Labreuche , Marco Pasi , Kevin Janot , Romain Bourcier , Igor Sibon , Arturo Consoli , Jean-Philippe Desilles , Jean-Marc Olivot , Chrysanthi Papagiannaki , Sebastien Soize , Jean-Christophe Gentric , Cyril Dargazanli , Jildaz Caroff , Raoul Pop , Olivier Naggara , Solene Moulin , Gaultier Marnat","doi":"10.1016/j.neurad.2024.01.076","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>The clinical benefit of mechanical thrombectomy(MT) for stroke patients with tandem occlusion is similar to that of isolated intracranial occlusions. However, the management of cervical internal carotid artery(ICA) occlusion during the MT, particularly in the setting of carotid dissection, remains controversial. We aimed to investigate the clinical impact of cervical ICA patency at day 1 on 3-month functional outcome.</p></div><div><h3>Methods</h3><p>We collected data from the Endovascular Treatment in Ischemic Stroke, a prospective national registry in 30 French centers performing MT between January 2015 and January 2022. Inclusion criteria were consecutive tandem occlusions related to cervical ICA dissection treated with MT. Tandem occlusions of other etiology, isolated cervical ICA occlusions without intracranial thrombus and patients without day-1 ICA imaging were excluded. Primary endpoint was the 3-month functional outcome. Secondary endpoints included intracranial hemorrhage(ICH), excellent outcome, mortality and early neurological improvement. A sensitivity analysis was performed in patients with intracranial favorable recanalization after MT.</p></div><div><h3>Results</h3><p>During the study period, 137 patients were included of which 89(65%) presented ICA patency at day 1. The odds of favorable outcome did not significantly differ between patients with patent and occluded ICA at day 1(68.7 vs 59.1%;aOR=1.30;95%CI 0.56-3.00,<em>p</em>=0.54). Excellent outcome, early neurological improvement, mortality and ICH were also comparable between groups. Sensitivity analysis showed similar results.</p></div><div><h3>Conclusion</h3><p>ICA patency at day 1 in patients with tandem occlusions related to dissection did not seem to influence functional outcome. Endovascular recanalization of the cervical ICA including stenting might not be systematically required in this setting.</p></div>","PeriodicalId":50115,"journal":{"name":"Journal of Neuroradiology","volume":null,"pages":null},"PeriodicalIF":3.0000,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0150986124000865/pdfft?md5=706f348582955ebcd2633c7bc6d7c9b4&pid=1-s2.0-S0150986124000865-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Impact of Day 1 carotid patency on outcome in dissection-related tandem occlusions treated with mechanical thrombectomy\",\"authors\":\"Guillaume Perrin , Elisabeth Molinier , Benjamin Gory , Maeva Kyheng , Julien Labreuche , Marco Pasi , Kevin Janot , Romain Bourcier , Igor Sibon , Arturo Consoli , Jean-Philippe Desilles , Jean-Marc Olivot , Chrysanthi Papagiannaki , Sebastien Soize , Jean-Christophe Gentric , Cyril Dargazanli , Jildaz Caroff , Raoul Pop , Olivier Naggara , Solene Moulin , Gaultier Marnat\",\"doi\":\"10.1016/j.neurad.2024.01.076\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>The clinical benefit of mechanical thrombectomy(MT) for stroke patients with tandem occlusion is similar to that of isolated intracranial occlusions. However, the management of cervical internal carotid artery(ICA) occlusion during the MT, particularly in the setting of carotid dissection, remains controversial. We aimed to investigate the clinical impact of cervical ICA patency at day 1 on 3-month functional outcome.</p></div><div><h3>Methods</h3><p>We collected data from the Endovascular Treatment in Ischemic Stroke, a prospective national registry in 30 French centers performing MT between January 2015 and January 2022. Inclusion criteria were consecutive tandem occlusions related to cervical ICA dissection treated with MT. Tandem occlusions of other etiology, isolated cervical ICA occlusions without intracranial thrombus and patients without day-1 ICA imaging were excluded. Primary endpoint was the 3-month functional outcome. Secondary endpoints included intracranial hemorrhage(ICH), excellent outcome, mortality and early neurological improvement. A sensitivity analysis was performed in patients with intracranial favorable recanalization after MT.</p></div><div><h3>Results</h3><p>During the study period, 137 patients were included of which 89(65%) presented ICA patency at day 1. The odds of favorable outcome did not significantly differ between patients with patent and occluded ICA at day 1(68.7 vs 59.1%;aOR=1.30;95%CI 0.56-3.00,<em>p</em>=0.54). Excellent outcome, early neurological improvement, mortality and ICH were also comparable between groups. Sensitivity analysis showed similar results.</p></div><div><h3>Conclusion</h3><p>ICA patency at day 1 in patients with tandem occlusions related to dissection did not seem to influence functional outcome. Endovascular recanalization of the cervical ICA including stenting might not be systematically required in this setting.</p></div>\",\"PeriodicalId\":50115,\"journal\":{\"name\":\"Journal of Neuroradiology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2024-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S0150986124000865/pdfft?md5=706f348582955ebcd2633c7bc6d7c9b4&pid=1-s2.0-S0150986124000865-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Neuroradiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0150986124000865\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Neuroradiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0150986124000865","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Impact of Day 1 carotid patency on outcome in dissection-related tandem occlusions treated with mechanical thrombectomy
Background
The clinical benefit of mechanical thrombectomy(MT) for stroke patients with tandem occlusion is similar to that of isolated intracranial occlusions. However, the management of cervical internal carotid artery(ICA) occlusion during the MT, particularly in the setting of carotid dissection, remains controversial. We aimed to investigate the clinical impact of cervical ICA patency at day 1 on 3-month functional outcome.
Methods
We collected data from the Endovascular Treatment in Ischemic Stroke, a prospective national registry in 30 French centers performing MT between January 2015 and January 2022. Inclusion criteria were consecutive tandem occlusions related to cervical ICA dissection treated with MT. Tandem occlusions of other etiology, isolated cervical ICA occlusions without intracranial thrombus and patients without day-1 ICA imaging were excluded. Primary endpoint was the 3-month functional outcome. Secondary endpoints included intracranial hemorrhage(ICH), excellent outcome, mortality and early neurological improvement. A sensitivity analysis was performed in patients with intracranial favorable recanalization after MT.
Results
During the study period, 137 patients were included of which 89(65%) presented ICA patency at day 1. The odds of favorable outcome did not significantly differ between patients with patent and occluded ICA at day 1(68.7 vs 59.1%;aOR=1.30;95%CI 0.56-3.00,p=0.54). Excellent outcome, early neurological improvement, mortality and ICH were also comparable between groups. Sensitivity analysis showed similar results.
Conclusion
ICA patency at day 1 in patients with tandem occlusions related to dissection did not seem to influence functional outcome. Endovascular recanalization of the cervical ICA including stenting might not be systematically required in this setting.
期刊介绍:
The Journal of Neuroradiology is a peer-reviewed journal, publishing worldwide clinical and basic research in the field of diagnostic and Interventional neuroradiology, translational and molecular neuroimaging, and artificial intelligence in neuroradiology.
The Journal of Neuroradiology considers for publication articles, reviews, technical notes and letters to the editors (correspondence section), provided that the methodology and scientific content are of high quality, and that the results will have substantial clinical impact and/or physiological importance.