Endovascular treatment of ischemic stroke due to isolated internal carotid artery occlusion: ETIS registry data analysis.
J Neurol. 2022-03-31; 269(8): 4383-4395
DOI: 10.1007/s00415-022-11078-y
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Ter Schiphorst A(1), Peres R(2), Dargazanli C(3), Blanc R(4), Gory B(5), Richard S(6), Marnat G(7), Sibon I(8), Guillon B(9), Bourcier R(10), Denier C(11), Spelle L(12), Labreuche J(13), Consoli A(14), Lapergue B(15), Costalat V(3), Obadia M(2), Arquizan C(16); ETIS Registry Investigators.
Collaborators: Costalat V, Gascou G, Lefèvre PH, Derraz I, Riquelme C, Gaillard
N, Mourand I, Corti L, Cagnazzo F, Ter Schiphorst A, Wang A, Evrard S, Maya
Tchikviladze, Ajili N, Lapergue B, Weisenburger-Lile D, Gorza L, Buard G, Coskun
O, Consoli A, Di Maria F, Rodesh G, Zimatore S, Leguen M, Gratieux J, Pico F,
Rakotoharinandrasana H, Tassan P, Poll R, Marinier S, Gory B, Bracard S,
Anxionnat R, Braun M, Derelle AL, Tonnelet R, Liao L, Zhu F, Schmitt E, Planel
S, Richard S, Humbertjean L, Mione G, Lacour JC, Riou-Comte N, Audibert G, Voicu
M, Alb L, Reitter M, Brezeanu M, Masson A, Tabarna A, Podar I, Marnat G, Gariel
F, Barreau X, Berge J, Veunac L, Menegon P, Sibon I, Lucas L, Olindo S, Renou P,
Sagnier S, Poli M, Debruxelles S, Rouanet F, Tourdias T, Liegey JS, Briau P,
Pangon N, Bourcier R, Detraz L, Daumas-Duport B, Alexandre PL, Roy M, Lenoble C,
Desal H, Guillon B, de Gaalon S, Preterre C, Piotin M, Blanc R, Redjem H,
Escalard S, Desilles JP, Delvoye F, Smajda S, Maier B, Solène Hebert, Mazighi M,
Obadia M, Sabben C, Seners P, Raynouard I, Corabianu O, de Broucker T, Manchon
E, Taylor G, Maacha MB, Laurie-Anne T, Augustin L, Julien S, Spelle L, Denier C,
Chassin O, Chalumeau V, Caroff J, Chassin O, Venditti L.
Author information:
(1)Department of Neurology, CHRU Gui de Chauliac, University Hospital of
Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, France.
(2)Department of Neurology, Fondation Rothschild Hospital, Paris, France.
(3)Department of Interventional Neuroradiology, CHRU Gui de Chauliac, University
Hospital of Montpellier, Montpellier, France.
(4)Department of Interventional Neuroradiology, Fondation Rothschild Hospital,
Paris, France.
(5)Department of Diagnostic and Therapeutic Neuroradiology, INSERM U1254,
Université de Lorraine, CHRU-Nancy, 54000, Nancy, France.
(6)Department of Neurology, Stroke Unit, INSERM U1116, 54000, Nancy, France.
(7)Department of Diagnostic and Interventional Neuroradiology, University
Hospital of Bordeaux, Bordeaux, France.
(8)Department of Neurology, Stroke Center, University Hospital of Bordeaux,
Bordeaux, France.
(9)Department of Neurology, University Hospital of Nantes, Nantes, France.
(10)Department of Neuroradiology, University Hospital of Nantes, Nantes, France.
(11)Department of Neurology, CHU Bicêtre, Le Kremlin Bicêtre, France.
(12)Department of Interventional Neuroradiology, CHU Bicêtre, Le Kremlin
Bicêtre, France.
(13)ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques
Médicales, Université de Lille, CHU Lille, 59000, Lille, France.
(14)Department of Neuroradiology, Foch Hospital, Suresnes, France.
(15)Department of Neurology, Foch Hospital, Suresnes, France.
(16)Department of Neurology, CHRU Gui de Chauliac, University Hospital of
Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, France.
.
BACKGROUND: The best treatment for acute ischemic stroke (AIS) due to isolated
cervical internal carotid artery occlusion (CICAO) (i.e., without associated
occlusion of the circle of Willis) is still unknown. In this study, we aimed to
describe EVT safety and clinical outcome in patients with CICAO.
METHODS: We analyzed data of all consecutive patients, included in the
Endovascular Treatment in Ischemic Stroke (ETIS) Registry between 2013 and 2020,
who presented AIS and proven CICAO on angiogram and underwent EVT. We assessed
carotid recanalization, procedural complications, National Institutes of Health
Stroke Scale (NIHSS) at 24 h post-EVT, and 3-month favorable outcome (modified
Rankin Scale, mRS ≤ 2 or equal to the pre-stroke value).
RESULTS: Forty-five patients were included (median age: 70 years; range:
62-82 years). The median NIHSS before EVT was 14 (9-21). Carotid stenting was
performed in 23 (51%) patients. Carotid recanalization at procedure end and on
control imaging was observed in 37 (82%) and 29 (70%) patients, respectively. At
day 1 post-EVT, the NIHSS remained stable or decreased in 25 (60%) patients; 12
(29%) patients had early neurologic deterioration (NIHSS ≥ 4 points). The rate
of procedural complications was 36%, including stent thrombosis (n = 7),
intracranial embolism (n = 7), and symptomatic intracranial hemorrhage (n = 1).
At 3 months, 18 (40%) patients had a favorable outcome, and 10 (22%) were dead.
CONCLUSION: Our study suggests that EVT in AIS patients with moderate/severe
initial deficit due to CICAO led to high rate of recanalization at day 1, and a
40% rate of favorable outcome at 3 months. There was a high rate of procedural
complication which is of concern. Randomized controlled trials assessing the
superiority of EVT in patients with CICAO and severe deficits are needed.
© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
DOI: 10.1007/s00415-022-11078-y
PMID: 35357557 [Indexed for MEDLINE]