Acute ischemic stroke with cervical internal carotid artery steno-occlusive lesion: multicenter analysis of endovascular approaches
Abstract Background Occlusion of the internal carotid artery (ICA), whether isolated or in the setting of a tandem lesion (TL) have a poor response to treatment with intravenous thrombolysis. Previous studies have demonstrated the superiority of mechanical thrombectomy in the treatment of acute is...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-09-01
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| Series: | BMC Neurology |
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| Online Access: | https://doi.org/10.1186/s12883-021-02393-4 |
| _version_ | 1818718463089180672 |
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| author | Luigi Cirillo Daniele Giuseppe Romano Gianfranco Vornetti Giulia Frauenfelder Chiara Tamburrano Francesco Taglialatela Salvatore Isceri Renato Saponiero Rosa Napoletano Mauro Gentile Michele Romoli Ciro Princiotta Luigi Simonetti Andrea Zini |
| author_facet | Luigi Cirillo Daniele Giuseppe Romano Gianfranco Vornetti Giulia Frauenfelder Chiara Tamburrano Francesco Taglialatela Salvatore Isceri Renato Saponiero Rosa Napoletano Mauro Gentile Michele Romoli Ciro Princiotta Luigi Simonetti Andrea Zini |
| author_sort | Luigi Cirillo |
| collection | DOAJ |
| description | Abstract Background Occlusion of the internal carotid artery (ICA), whether isolated or in the setting of a tandem lesion (TL) have a poor response to treatment with intravenous thrombolysis. Previous studies have demonstrated the superiority of mechanical thrombectomy in the treatment of acute ischemic stroke (AIS) following large vessel occlusion, compared to standard intravenous fibrinolysis. The aim of our study was to describe endovascular treatment (EVT) in AIS due to isolated ICA occlusion or TL. Methods We assessed the association between 90-day outcome and clinical, demographic, imaging, and procedure data in 51 consecutive patients with acute isolated ICA occlusion or TL who underwent EVT. We evaluated baseline NIHSS and mRS, ASPECTS, type of occlusion, stent placement, use of stent retrievers and/or thromboaspiration, duration of the procedure, mTICI, postprocedural therapy and complications. Results A favorable 90-day outcome (mRS 0–2) was achieved in 34 patients (67 %) and was significantly associated with the use of dual antiplatelet therapy after the procedure (p = 0.008), shorter procedure duration (p = 0.031), TICI 2b-3 (p < 0.001) and lack of post-procedural hemorrhagic transformation (p = 0.001). Four patients did not survive, resulting in a mortality rate of 8 %. Conclusions Our study has shown that EVT in the treatment of AIS due to ICA occlusion is safe, and effective in determining a good functional outcome. ICA stenting led to good angiographic results and therapy with a glycoprotein IIb / IIIa inhibitor immediately after stent release did not result in a greater risk of hemorrhage. The use of post-procedural dual antiplatelet therapy was associated with favorable outcome, without a significant increase in hemorrhagic transformation. |
| first_indexed | 2024-12-17T19:51:27Z |
| format | Article |
| id | doaj.art-a48a19bcc3174ee388cfaf9fd9ef9c48 |
| institution | Directory Open Access Journal |
| issn | 1471-2377 |
| language | English |
| last_indexed | 2024-12-17T19:51:27Z |
| publishDate | 2021-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Neurology |
| spelling | doaj.art-a48a19bcc3174ee388cfaf9fd9ef9c482022-12-21T21:34:43ZengBMCBMC Neurology1471-23772021-09-0121111110.1186/s12883-021-02393-4Acute ischemic stroke with cervical internal carotid artery steno-occlusive lesion: multicenter analysis of endovascular approachesLuigi Cirillo0Daniele Giuseppe Romano1Gianfranco Vornetti2Giulia Frauenfelder3Chiara Tamburrano4Francesco Taglialatela5Salvatore Isceri6Renato Saponiero7Rosa Napoletano8Mauro Gentile9Michele Romoli10Ciro Princiotta11Luigi Simonetti12Andrea Zini13Department of Experimental, Diagnostic and Speciality Medicine, University of BolognaUOC Neuroradiologia AOU S. Giovanni di Dio e Ruggi d’AragonaDepartment of Experimental, Diagnostic and Speciality Medicine, University of BolognaUOC Neuroradiologia AOU S. Giovanni di Dio e Ruggi d’AragonaDepartment of Experimental, Diagnostic and Speciality Medicine, University of BolognaUOSI Neuroradiologia Ospedale Maggiore CA Pizzardi - IRCCS delle scienze Neurologiche di BolognaUOSI Neuroradiologia Ospedale Maggiore CA Pizzardi - IRCCS delle scienze Neurologiche di BolognaUOC Neuroradiologia AOU S. Giovanni di Dio e Ruggi d’AragonaUOC Neurologia AOU S. Giovanni di Dio e Ruggi d’AragonaUOC Neurologia e Rete Stroke metropolitana Ospedale Maggiore CA Pizzardi - IRCCS delle scienze Neurologiche di BolognaUOC Neurologia e Rete Stroke metropolitana Ospedale Maggiore CA Pizzardi - IRCCS delle scienze Neurologiche di BolognaUOSI Neuroradiologia Ospedale Maggiore CA Pizzardi - IRCCS delle scienze Neurologiche di BolognaUOSI Neuroradiologia Ospedale Maggiore CA Pizzardi - IRCCS delle scienze Neurologiche di BolognaUOC Neurologia e Rete Stroke metropolitana Ospedale Maggiore CA Pizzardi - IRCCS delle scienze Neurologiche di BolognaAbstract Background Occlusion of the internal carotid artery (ICA), whether isolated or in the setting of a tandem lesion (TL) have a poor response to treatment with intravenous thrombolysis. Previous studies have demonstrated the superiority of mechanical thrombectomy in the treatment of acute ischemic stroke (AIS) following large vessel occlusion, compared to standard intravenous fibrinolysis. The aim of our study was to describe endovascular treatment (EVT) in AIS due to isolated ICA occlusion or TL. Methods We assessed the association between 90-day outcome and clinical, demographic, imaging, and procedure data in 51 consecutive patients with acute isolated ICA occlusion or TL who underwent EVT. We evaluated baseline NIHSS and mRS, ASPECTS, type of occlusion, stent placement, use of stent retrievers and/or thromboaspiration, duration of the procedure, mTICI, postprocedural therapy and complications. Results A favorable 90-day outcome (mRS 0–2) was achieved in 34 patients (67 %) and was significantly associated with the use of dual antiplatelet therapy after the procedure (p = 0.008), shorter procedure duration (p = 0.031), TICI 2b-3 (p < 0.001) and lack of post-procedural hemorrhagic transformation (p = 0.001). Four patients did not survive, resulting in a mortality rate of 8 %. Conclusions Our study has shown that EVT in the treatment of AIS due to ICA occlusion is safe, and effective in determining a good functional outcome. ICA stenting led to good angiographic results and therapy with a glycoprotein IIb / IIIa inhibitor immediately after stent release did not result in a greater risk of hemorrhage. The use of post-procedural dual antiplatelet therapy was associated with favorable outcome, without a significant increase in hemorrhagic transformation.https://doi.org/10.1186/s12883-021-02393-4Acute ischemic strokeInternal carotid artery occlusionTandem lesionEndovascular treatment. |
| spellingShingle | Luigi Cirillo Daniele Giuseppe Romano Gianfranco Vornetti Giulia Frauenfelder Chiara Tamburrano Francesco Taglialatela Salvatore Isceri Renato Saponiero Rosa Napoletano Mauro Gentile Michele Romoli Ciro Princiotta Luigi Simonetti Andrea Zini Acute ischemic stroke with cervical internal carotid artery steno-occlusive lesion: multicenter analysis of endovascular approaches BMC Neurology Acute ischemic stroke Internal carotid artery occlusion Tandem lesion Endovascular treatment. |
| title | Acute ischemic stroke with cervical internal carotid artery steno-occlusive lesion: multicenter analysis of endovascular approaches |
| title_full | Acute ischemic stroke with cervical internal carotid artery steno-occlusive lesion: multicenter analysis of endovascular approaches |
| title_fullStr | Acute ischemic stroke with cervical internal carotid artery steno-occlusive lesion: multicenter analysis of endovascular approaches |
| title_full_unstemmed | Acute ischemic stroke with cervical internal carotid artery steno-occlusive lesion: multicenter analysis of endovascular approaches |
| title_short | Acute ischemic stroke with cervical internal carotid artery steno-occlusive lesion: multicenter analysis of endovascular approaches |
| title_sort | acute ischemic stroke with cervical internal carotid artery steno occlusive lesion multicenter analysis of endovascular approaches |
| topic | Acute ischemic stroke Internal carotid artery occlusion Tandem lesion Endovascular treatment. |
| url | https://doi.org/10.1186/s12883-021-02393-4 |
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