Abstract
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.
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Data availability statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Abbreviations
- ASPECTS:
-
Alberta stroke program early CT score
- CICAO:
-
Cervical isolated internal carotid artery occlusion
- CT:
-
Computed tomography
- DSA:
-
Digital subtraction angiography
- END:
-
Early neurological deterioration
- ETIS:
-
Endovascular treatment in ischemic stroke
- EVT:
-
Endovascular treatment
- ICA:
-
Internal carotid artery
- IVT:
-
Intravenous thrombolysis
- LVO:
-
Large vessel occlusion
- MRI:
-
Magnetic resonance imaging
- mRS:
-
Modified rankin scale
- NIHSS:
-
National institutes of health stroke scale
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Acknowledgements
We would like to thank Jessica Hattinguais and Amel Benali for their help in data collection. On behalf of the ETIS-Research Investigators: CHRU Montpellier: Cyril Dargazanli, Caroline Arquizan, Vincent Costalat, Grégory Gascou, Pierre-Henri Lefèvre, Imad Derraz, Carlos Riquelme, Nicolas Gaillard, Isabelle Mourand, Lucas Corti, Federico Cagnazzo, Adrien ter Schiphorst; Hôpital Foch: Adrien Wang, Serge Evrard, Maya.Tchikviladze, Nadia Ajili, Bertrand Lapergue, David Weisenburger-Lile, Lucas Gorza, Géraldine Buard, Oguzhan Coskun, Arturo Consoli, Federico Di Maria, Georges Rodesh, Sergio Zimatore, Morgan Leguen, Julie Gratieux, Fernando Pico, Haja Rakotoharinandrasana, Philippe Tassan, Roxanna Poll, Sylvie Marinier; CHRU-Nancy: Benjamin Gory, Serge Bracard, René Anxionnat, Marc Braun, Anne-Laure Derelle, Romain Tonnelet, Liang Liao, François Zhu, Emmanuelle Schmitt, Sophie Planel, Sébastien Richard, Lisa Humbertjean, Gioia Mione, Jean-Christophe Lacour, Nolwenn Riou-Comte, Gérard Audibert, Marcela Voicu, Lionel Alb, Marie Reitter, Madalina Brezeanu, Agnès Masson, Adriana Tabarna, Iona Podar; CHRU Bordeaux: Gaultier Marnat, Florent Gariel, Xavier Barreau, Jérôme Berge, Louis Veunac, Patrice Menegon, Igor Sibon, Ludovic Lucas, Stéphane Olindo, Pauline Renou, Sharmila Sagnier, Mathilde Poli, Sabrina Debruxelles, François Rouanet, Thomas Tourdias, Jean-Sebastien Liegey, Pierre Briau, Nicolas Pangon; CHRU Nantes: Romain Bourcier, Lili Detraz, Benjamin Daumas-Duport, Pierre-Louis Alexandre, Monica Roy, Cédric Lenoble, Hubert Desal, Benoît Guillon, Solène de Gaalon, Cécile Preterre; Fondation Rothschild: Michel Piotin, Raphaël Blanc, Hocine Redjem, Simon Escalard, Jean-Philippe Desilles, François Delvoye, Stanislas Smajda, Benjamin Maier, Solène Hebert, Mikaël Mazighi, Mikael Obadia, Candice Sabben, Pierre Seners, Igor Raynouard, Ovide Corabianu, Thomas de Broucker, Eric Manchon, Guillaume Taylor, Malek Ben Maacha, Thion Laurie-Anne, Lecler Augustin, Savatovsjy Julien; Hôpital Kremlin-Bicêtre: Laurent Spelle, Christian Denier, Olivier Chassin, Vanessa Chalumeau, Jildaz Caroff, Olivier Chassin, Laura Venditti
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This research received no specific Grant from any funding agency in the public, commercial or not-for-profit sectors.
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CA, AtS, RP, BL, MO, and CD: carried out the study design, planned the study data collection, participated to the interpretation of data, drafted and critically revised the manuscript, and approved the final version to be published. JL made the data analysis and interpretation, critically revised the manuscript, and approved the final version to be published. BR, GB, RS, MG, SI, GB, BR, DC, SL, CA, and CV: made substantial contributions to the acquisition of the data, critically revised the manuscript, and approved the final version to be published. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
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The ETIS Registry Investigators member names are listed in Acknowledgement section.
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ter Schiphorst, A., Peres, R., Dargazanli, C. et al. Endovascular treatment of ischemic stroke due to isolated internal carotid artery occlusion: ETIS registry data analysis. J Neurol 269, 4383–4395 (2022). https://doi.org/10.1007/s00415-022-11078-y
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DOI: https://doi.org/10.1007/s00415-022-11078-y