Abstract
Purpose
Intracranial carotid artery occlusion represents an underinvestigated cause of acute ischemic stroke as well as an indication for mechanical thrombectomy. We investigated baseline and procedural characteristics, outcomes and predictors of outcome in patients with acute ischemic stroke secondary to intracranial carotid artery occlusion.
Methods
A retrospective analysis of the Italian Registry of Endovascular Treatment in Acute Stroke was performed. Patients with intracranial carotid artery occlusion (infraclinoid and supraclinoid) with or without cervical artery occlusion but with patent intracranial arteries were included. The 3‑month functional independence, mortality, successful reperfusion and symptomatic intracranial hemorrhage were evaluated.
Results
Intracranial carotid artery occlusion with patent intracranial arteries was diagnosed in 387 out of 4940 (7.8%) patients. The median age was 74 years and median baseline National Institute of Health Stroke Scale (NIHSS) was 18. Functional independence was achieved in 130 (34%) patients, successful reperfusion in 289 (75%) and symptomatic intracranial hemorrhage in 33 (9%), whereas mortality occurred in 111 (29%) patients. In univariate analysis functional independence was associated with lower age, lower NIHSS at presentation, higher rate of successful reperfusion and lower rate of symptomatic intracranial hemorrhage. Multivariable regression analysis found age (odds ratio, OR:1.03; P = 0.006), NIHSS at presentation (OR: 1.07; P < 0.001), diabetes (OR: 2.60; P = 0.002), successful reperfusion (OR:0.20; P < 0.001) and symptomatic intracranial hemorrhage (OR: 4.17; P < 0.001) as the best independent predictors of outcome.
Conclusion
Our study showed a not negligible rate of intracranial carotid artery occlusion with patent intracranial arteries, presenting mostly as severe stroke, with an acceptable rate of 3‑month functional independence. Age, NIHSS at presentation and successful reperfusion were the best independent predictors of outcome.
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Funding
The project “Registro Nazionale Trattamento Ictus Acuto” (RFPS-2006-1-336562) was funded by grants from the Italian Ministry of Health within the framework of 2006 Finalized Research Programmes (D.Lgs.n.502/1992).
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M. Bergui received consulting fees from Penumbra Inc. and Stryker. Dr Saletti received consulting fees from Stryker. A. De Vito received speaker fees and serves as advisory board from Boehringer-Ingelheim and Daiichi Sankyo. A. Zini received speaker fees and consulting fees from Boehringer-Ingelheim, Medtronic, Cerenovus and serves as advisory board from Daiichi Sankyo and Boehringer-Ingelheim and Stryker. N. P. Nuzzi received consulting fees from Penumbra Inc. and Acandis GmbH. S. Sacco received consulting fees from Allergan, Abbott, Eli Lilly. F. Sallustio, V. Saia, F. Marrama, G. Pracucci, R. Gandini, G. Koch, A. P. Mascolo, F. D’Agostino, A. Rocco, R. Argiro’, M. Nezzo, D. Morosetti, A. Wlderk, V. Da Ros, M. Diomedi, L. Renieri, P. Nencini, S. Vallone, G. Bigliardi, A. Caragliano, I. Francalanza, S. Bracco, R. Tassi, A. Naldi, A. Saletti, , R. Gasparotti, M. Magoni, L. Cirillo, C. Commodaro, S. Biguzzi, L. Castellan, L. Malfatto, R. Menozzi, I. Grisendi, M. Cosottini, G. Orlandi, A. Comai, E. Franchini, F. D’Argento, G. Frisullo, E. Puglielli, A. Casalena, F. Causin, C. Baracchini, A. Boghi, G. Chianale, R. Augelli, M. Cappellari, L. Chiumarulo, M. Petruzzellis, A. Sgreccia, Piera Tosi, N. Cavasin, A. Critelli, V. Semeraro, G. Boero, F. Vizzari, L.P. Cariddi, O. Di Benedetto, P. Pugliese, M. Iacobucci, M. De Michele, F. Fusaro, J. Moller, L. Allegretti, T. Tassinari, S. Marcheselli, M. Pavia, P. Invernizzi, I. Gallesio, L. Ruiz, S. Zedda, R. Rossi, P. Amistà, M. Russo, F. Pintus, A. Sanna, G. Craparo, M. Mannino, D. Inzitari, S. Mangiafico and D. Toni declare that they have no competing interests.
Ethical standards
All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Need for ethical approval or patient consent for participation in the IRETAS varied among participating hospitals. Informed consent was obtained from all individual participants included in the study.
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Data supporting the findings of this study are available upon reasonable request (coordinamento@registroendovascolare.it).
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Sallustio, F., Saia, V., Marrama, F. et al. Mechanical Thrombectomy for Acute Intracranial Carotid Occlusion with Patent Intracranial Arteries. Clin Neuroradiol 31, 21–29 (2021). https://doi.org/10.1007/s00062-020-00980-5
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DOI: https://doi.org/10.1007/s00062-020-00980-5