Mpotsaris, Anastasios ORCID: 0000-0002-1275-8164, Kabbasch, Christoph, Borggrefe, Jan ORCID: 0000-0003-2908-7560, Gontu, Vamsi and Soderman, Michael (2017). Stenting of the cervical internal carotid artery in acute stroke management: The Karolinska experience. Interv. Neuroradiol., 23 (2). S. 159 - 166. THOUSAND OAKS: SAGE PUBLICATIONS INC. ISSN 2385-2011

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Abstract

Background: Emergency stent placement in the extracranial internal carotid artery in combination with anterior circulation thrombectomy is a routine procedure. Yet, precise indications and clinical safety in this setting remains controversial. Present data for mechanical thrombectomy include few studies with acute stenting of tandem occlusions. We evaluated the feasibility, safety and clinical outcome of this endovascular treatment in a retrospective analysis of all consecutive cases at a comprehensive stroke centre. Methods: This was a retrospective analysis of all consecutive patients with acute extracranial carotid artery occlusion including acute dissection or high-grade stenosis and concomitant intracranial large-vessel occlusion treated with emergency carotid stenting and intracranial mechanical thrombectomy between November 2007 and May 2015. Results: A total of 63 patients with a median age of 67 years (range 33-84 years) were treated. Of these, 33 (52%) patients had concomitant intravenous thrombolysis with recombinant tissue-type plasminogen activator initially. Median admission National Institutes of Health Stroke Scale was 14 (range 1-29). Median time from stroke onset to recanalization was 408 minutes (range 165-1846 minutes). Procedure time was significantly shorter after intravenous thrombolysis (110 minutes [range 15-202 minutes] vs. 130 minutes [range 60-280 minutes]; p = 0.02). Three (5%) patients experienced post-procedural symptomatic intracerebral haemorrhage. In 55/63 (87%) patients, a score of >= 2b on the Thrombolysis in Cerebral Infarction scale could be achieved. Eight (13%) patients died, five (8%) during the acute phase. A total of 29/63 (46%) patients showed a favourable outcome (modified Rankin Scale score of 0-2) after three months. Conclusions: Our single-centre retrospective analysis of emergency stent placement in the extracranial internal carotid artery in combination with anterior circulation thrombectomy demonstrated high technical success, reasonable clinical outcomes and acceptable rates of symptomatic intracranial haemorrhage in carefully chosen patients which are triaged interdisciplinary based on clinical and computed tomography imaging criteria. This warrants further study in a randomised prospective trial.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Mpotsaris, AnastasiosUNSPECIFIEDorcid.org/0000-0002-1275-8164UNSPECIFIED
Kabbasch, ChristophUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Borggrefe, JanUNSPECIFIEDorcid.org/0000-0003-2908-7560UNSPECIFIED
Gontu, VamsiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Soderman, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-235968
DOI: 10.1177/1591019916681983
Journal or Publication Title: Interv. Neuroradiol.
Volume: 23
Number: 2
Page Range: S. 159 - 166
Date: 2017
Publisher: SAGE PUBLICATIONS INC
Place of Publication: THOUSAND OAKS
ISSN: 2385-2011
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
ACUTE ISCHEMIC-STROKE; TISSUE-PLASMINOGEN ACTIVATOR; SINGLE-CENTER EXPERIENCE; TANDEM OCCLUSIONS; ENDOVASCULAR TREATMENT; INTRACRANIAL THROMBECTOMY; MECHANICAL THROMBECTOMY; INTRAARTERIAL TREATMENT; ANTERIOR CIRCULATION; THROMBOLYSISMultiple languages
Clinical Neurology; Radiology, Nuclear Medicine & Medical ImagingMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/23596

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