1. Stable Extracranial ICA Patency after Mechanical Thrombectomy for Ischemic Stroke Patients with Tandem Occlusions: Major determinant of favorable outcome.
- Author
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Personnic, T., Bricout, N., Henon, H., Bretzner, M., Lemesle, G., and Pruvo, J.P.
- Abstract
Background Mechanical thrombectomy (MT) for acute ischemic stroke (AIS) with tandem occlusion is efficient, but optimal management of the extracranial occlusive component remains controversial. We investigated the association between extracranial internal carotid artery (ICA) patency on day 1 follow-up MR-Angiography and clinical outcome after MT in AIS patients with tandem occlusion. Methods Consecutive AIS patients with tandem occlusion were identified from a hospital-based prospective registry from January 2011 to January 2017. Baseline clinical-imaging characteristics, angiographic outcomes and day 1 follow-up imaging findings (including extracranial ICA patency as assessed by MR-Angiography) were analyzed with regards to their associations with 3-month modified Rankin scale (mRS) scores. Favorable outcome was defined as a mRS score 0–2 at 3 months. Results Out of 594 AIS patients treated with MT during the study period, 83 met inclusion criteria (69.9% male, aged 62.3 ± 12.3). Mean NIHSS was 17.9 ± 4.8 and median ASPECTS was 7. Successful re-canalization (mTICI 2b/3) was achieved in 61.5%. Extracranial ICA was patent in 37/83 patients (44.6%) at day 1, more frequently in those with prior IV thrombolysis (P = 0.035) or with cervical re-vascularization procedure (balloon angioplasty or stenting, P = 0.034). Favorable 3-month functional outcome was more frequent in patients with patent extracranial ICA at day 1 (64.9% vs 21.7%, P < 0.0001) independently of intracranial recanalization success. No difference was found in terms of sICH (13.5% vs 10.9%, P = 0.75) or 3-month mortality rate (8.1% vs 17.4%, P = 0.33). Conclusion This study highlights the importance of stable extracranial ICA patency in determining outcome of AIS patients with tandem occlusions. Randomized studies are needed. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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