Immediate Carotid Artery Stenting or Deferred Treatment in Patients With Tandem Carotid Lesions Treated Endovascularly for Acute Ischaemic Stroke
Fifteen to 20% of patients with an acute ischaemic stroke have a tandem lesion defined by the combination of an intracranial large vessel thrombo-embolic occlusion and a high grade stenosis or occlusion of the ipsilateral internal carotid artery. These patients tend to have worse outcomes than patie...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-01-01
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| Series: | EJVES Vascular Forum |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666688X23000941 |
| _version_ | 1797366619928788992 |
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| author | Theodora van Elk Louise Maes Anne van der Meij Robin Lemmens Maarten Uyttenboogaart Gert J. de Borst Clark J. Zeebregts Paul J. Nederkoorn |
| author_facet | Theodora van Elk Louise Maes Anne van der Meij Robin Lemmens Maarten Uyttenboogaart Gert J. de Borst Clark J. Zeebregts Paul J. Nederkoorn |
| author_sort | Theodora van Elk |
| collection | DOAJ |
| description | Fifteen to 20% of patients with an acute ischaemic stroke have a tandem lesion defined by the combination of an intracranial large vessel thrombo-embolic occlusion and a high grade stenosis or occlusion of the ipsilateral internal carotid artery. These patients tend to have worse outcomes than patients with isolated intracranial occlusions, with higher rates of disability and death. The introduction of endovascular thrombectomy to treat the intracranial lesion clearly improved the outcome compared with treatment with intravenous thrombolysis alone. However, the best treatment strategy for managing the extracranial carotid artery lesion in patients with tandem lesions remains unknown. Current guidelines recommend carotid endarterectomy for patients with transient ischaemic attack or non-disabling stroke and moderate or severe stenosis of the internal carotid artery, within two weeks of the initial event, to prevent major stroke recurrence and death. Alternatively, the symptomatic carotid artery could be treated by endovascular placement of a stent during endovascular thrombectomy (EVT). This would negate the need for a second procedure, immediately reduce the risk of stroke recurrence, increase patient satisfaction, and could be cost effective. However, the administration of dual antiplatelet therapy could potentially increase the risk of symptomatic intracranial haemorrhage in patients with acute ischaemic stroke. Randomised controlled trials evaluating the efficacy and safety of immediate carotid artery stenting during EVT in acute stroke patients with tandem lesions are currently ongoing and will impact the current guidelines regarding the treatment of patients with acute ischaemic stroke due to these tandem lesions. |
| first_indexed | 2024-03-08T17:06:18Z |
| format | Article |
| id | doaj.art-d713787310b7469ebc1dcae2ec7de30d |
| institution | Directory Open Access Journal |
| issn | 2666-688X |
| language | English |
| last_indexed | 2024-03-08T17:06:18Z |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EJVES Vascular Forum |
| spelling | doaj.art-d713787310b7469ebc1dcae2ec7de30d2024-01-04T04:40:00ZengElsevierEJVES Vascular Forum2666-688X2024-01-01613135Immediate Carotid Artery Stenting or Deferred Treatment in Patients With Tandem Carotid Lesions Treated Endovascularly for Acute Ischaemic StrokeTheodora van Elk0Louise Maes1Anne van der Meij2Robin Lemmens3Maarten Uyttenboogaart4Gert J. de Borst5Clark J. Zeebregts6Paul J. Nederkoorn7Department of Neurology, University Medical Centre Groningen, Groningen, the Netherlands; Corresponding author. University Medical Centre Groningen t.a.v. Neurologie AB51, Postbus 30.001, 9700RB Groningen, the Netherlands.Department of Neurology, University Hospital Leuven, Leuven, Belgium; Department of Neurosciences, Experimental Neurology, KULeuven - University of Leuven, Leuven, BelgiumDepartment of Neurology, Amsterdam University Medical Centre, Amsterdam, the Netherlands; Department of Neurology, Leiden University Medical Centre, Leiden, the NetherlandsDepartment of Neurology, University Hospital Leuven, Leuven, Belgium; Department of Neurosciences, Experimental Neurology, KULeuven - University of Leuven, Leuven, BelgiumDepartment of Neurology, University Medical Centre Groningen, Groningen, the NetherlandsDepartment of Surgery (Division of Vascular Surgery), University Medical Centre Utrecht, Utrecht, the NetherlandsDepartment of Surgery (Division of Vascular Surgery), University Medical Centre Groningen, Groningen, the NetherlandsDepartment of Neurology, Amsterdam University Medical Centre, Amsterdam, the NetherlandsFifteen to 20% of patients with an acute ischaemic stroke have a tandem lesion defined by the combination of an intracranial large vessel thrombo-embolic occlusion and a high grade stenosis or occlusion of the ipsilateral internal carotid artery. These patients tend to have worse outcomes than patients with isolated intracranial occlusions, with higher rates of disability and death. The introduction of endovascular thrombectomy to treat the intracranial lesion clearly improved the outcome compared with treatment with intravenous thrombolysis alone. However, the best treatment strategy for managing the extracranial carotid artery lesion in patients with tandem lesions remains unknown. Current guidelines recommend carotid endarterectomy for patients with transient ischaemic attack or non-disabling stroke and moderate or severe stenosis of the internal carotid artery, within two weeks of the initial event, to prevent major stroke recurrence and death. Alternatively, the symptomatic carotid artery could be treated by endovascular placement of a stent during endovascular thrombectomy (EVT). This would negate the need for a second procedure, immediately reduce the risk of stroke recurrence, increase patient satisfaction, and could be cost effective. However, the administration of dual antiplatelet therapy could potentially increase the risk of symptomatic intracranial haemorrhage in patients with acute ischaemic stroke. Randomised controlled trials evaluating the efficacy and safety of immediate carotid artery stenting during EVT in acute stroke patients with tandem lesions are currently ongoing and will impact the current guidelines regarding the treatment of patients with acute ischaemic stroke due to these tandem lesions.http://www.sciencedirect.com/science/article/pii/S2666688X23000941Acute ischaemic strokeCarotid arteryCarotid artery stentingEndovascular thrombectomyLarge vessel occlusionTandem lesion |
| spellingShingle | Theodora van Elk Louise Maes Anne van der Meij Robin Lemmens Maarten Uyttenboogaart Gert J. de Borst Clark J. Zeebregts Paul J. Nederkoorn Immediate Carotid Artery Stenting or Deferred Treatment in Patients With Tandem Carotid Lesions Treated Endovascularly for Acute Ischaemic Stroke EJVES Vascular Forum Acute ischaemic stroke Carotid artery Carotid artery stenting Endovascular thrombectomy Large vessel occlusion Tandem lesion |
| title | Immediate Carotid Artery Stenting or Deferred Treatment in Patients With Tandem Carotid Lesions Treated Endovascularly for Acute Ischaemic Stroke |
| title_full | Immediate Carotid Artery Stenting or Deferred Treatment in Patients With Tandem Carotid Lesions Treated Endovascularly for Acute Ischaemic Stroke |
| title_fullStr | Immediate Carotid Artery Stenting or Deferred Treatment in Patients With Tandem Carotid Lesions Treated Endovascularly for Acute Ischaemic Stroke |
| title_full_unstemmed | Immediate Carotid Artery Stenting or Deferred Treatment in Patients With Tandem Carotid Lesions Treated Endovascularly for Acute Ischaemic Stroke |
| title_short | Immediate Carotid Artery Stenting or Deferred Treatment in Patients With Tandem Carotid Lesions Treated Endovascularly for Acute Ischaemic Stroke |
| title_sort | immediate carotid artery stenting or deferred treatment in patients with tandem carotid lesions treated endovascularly for acute ischaemic stroke |
| topic | Acute ischaemic stroke Carotid artery Carotid artery stenting Endovascular thrombectomy Large vessel occlusion Tandem lesion |
| url | http://www.sciencedirect.com/science/article/pii/S2666688X23000941 |
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