Ces radiol. 2019, 73(1):7-12 | DOI: 10.55095/CesRadiol2019/002

Stenting of cervical internal carotid artery in patients with acute ischemic stroke due to tandem occlusion. Is antegrade approach safe?Original article

Martin Köcher¹, Daniel Šaňák², Jana Zapletalová³, Marie Černá¹, Tomáš Veverka², Vojtěch Prášil¹, Milan Král²

¹ Radiologická klinika, Komplexní cerebrovaskulární centrum FN a LF, Olomouc

² Neurologická klinika, Komplexní cerebrovaskulární centrum FN a LF, Olomouc

³ Ústav lékařské biofyziky LF UP, Olomouc

Purpose: The mechanical thrombectomy became a standard treatment option in acute ischemic stroke patients with a symptomatic occlusion of large cerebral artery within first six hours after stroke onset. Acute ischemic stroke can also be caused by tandem occlusion. The aim of our retrospective study was to evaluate safety of carotid artery stenting and subsequent mechanical trombectomy (antegrade approach).

Methods: All consecutive IS patients treated due to tandem occlusion were enrolled into the retrospective analysis. Neurological deficit was scored using National Institutes of Health Stroke Scale (NIHSS). In all patients we used antegrade technique. Achieved recanalization was rated using Thrombolysis in Cerebral Infarction (TICI) scale. Symptomatic intracerebral haemorrhage (SICH) was assessed according to the SITS-MOST criteria. Ninety day clinical outcome was scored using modified Rankin (mRS) scale with score 0-2 for good outcome.

Results: In total 39 patients (79.5% of males, mean age 65.7 years) were treated for TO with a mean score of admission NIHSS 15 points. Overall recanalization (TICI2b/3) was achieved in 94.9% and complete (TICI 3) in 59% of patients. SICH after procedure was detected in 4 patients (10.3%). A good 90-day clinical outcome after 3 months was achieved in 22 patients (56.4%). The rate of 3-month mortality was 15.4%. In the statistical comparison, there was a significant difference in the patency of single-layer and double-layered stents in the early post-operative period (100% vs. 73.3%, p = 0.023), but no significant relationship between stent type and 90-day mRS was found (p = 0.123).

Conclusion: Antegrade treatment technique of ischemic stroke patients with tandem occlusion is effective and safe. The use of dual-layer stents increase the risk of early occlusion of the extracranial portion of the ACI, but does not affect the clinical outcome.

Keywords: acute ischemic stroke, tandem occlusion, mechanical thrombectomy, stent-retriever, internal carotic artery, stent

Grants and funding:

Práce byla podpořena grantem RVO FNOL_00098892_2016.

Accepted: April 8, 2019; Published: March 1, 2019  Show citation