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Endovascular treatment of ischemic stroke due to isolated internal carotid artery occlusion: ETIS registry data analysis

  • Original Communication
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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

Funding

This research received no specific Grant from any funding agency in the public, commercial or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Neurology, CHRU Gui de Chauliac, University Hospital of Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, France

    Adrien ter Schiphorst & Caroline Arquizan

  2. Department of Neurology, Fondation Rothschild Hospital, Paris, France

    Roxane Peres & Michael Obadia

  3. Department of Interventional Neuroradiology, CHRU Gui de Chauliac, University Hospital of Montpellier, Montpellier, France

    Cyril Dargazanli & Vincent Costalat

  4. Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France

    Raphaël Blanc

  5. Department of Diagnostic and Therapeutic Neuroradiology, INSERM U1254, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France

    Benjamin Gory

  6. Department of Neurology, Stroke Unit, INSERM U1116, 54000, Nancy, France

    Sébastien Richard

  7. Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France

    Gaultier Marnat

  8. Department of Neurology, Stroke Center, University Hospital of Bordeaux, Bordeaux, France

    Igor Sibon

  9. Department of Neurology, University Hospital of Nantes, Nantes, France

    Benoit Guillon

  10. Department of Neuroradiology, University Hospital of Nantes, Nantes, France

    Romain Bourcier

  11. Department of Neurology, CHU Bicêtre, Le Kremlin Bicêtre, France

    Christian Denier

  12. Department of Interventional Neuroradiology, CHU Bicêtre, Le Kremlin Bicêtre, France

    Laurent Spelle

  13. ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Université de Lille, CHU Lille, 59000, Lille, France

    Julien Labreuche

  14. Department of Neuroradiology, Foch Hospital, Suresnes, France

    Arturo Consoli

  15. Department of Neurology, Foch Hospital, Suresnes, France

    Bertrand Lapergue

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  1. Adrien ter Schiphorst
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  2. Roxane Peres
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  3. Cyril Dargazanli
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  4. Raphaël Blanc
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  5. Benjamin Gory
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  16. Vincent Costalat
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  18. Caroline Arquizan
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Consortia

the ETIS Registry Investigators

  • Vincent Costalat
  • , Grégory Gascou
  • , Pierre-Henri Lefèvre
  • , Imad Derraz
  • , Carlos Riquelme
  • , Nicolas Gaillard
  • , Isabelle Mourand
  • , Lucas Corti
  • , Federico Cagnazzo
  • , Adrien ter Schiphorst
  • , 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
  • , 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
  • , 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
  • , Romain Bourcier
  • , Lili Detraz
  • , Benjamin Daumas-Duport
  • , Pierre-Louis Alexandre
  • , Monica Roy
  • , Cédric Lenoble
  • , Hubert Desal
  • , Benoît Guillon
  • , Solène de Gaalon
  • , Cécile Preterre
  • , 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
  • , Laurent Spelle
  • , Christian Denier
  • , Olivier Chassin
  • , Vanessa Chalumeau
  • , Jildaz Caroff
  • , Olivier Chassin
  •  & Laura Venditti

Contributions

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.

Corresponding author

Correspondence to Caroline Arquizan.

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Conflicts of interest

None declared.

Additional information

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

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