scholarly journals Stenting of the cervical internal carotid artery in acute stroke management: The Karolinska experience

2016 ◽  
Vol 23 (2) ◽  
pp. 159-165 ◽  
Author(s):  
Anastasios Mpotsaris ◽  
Christoph Kabbasch ◽  
Jan Borggrefe ◽  
Vamsi Gontu ◽  
Michael Soderman
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Retrospective Analysis ◽  
Stent Placement ◽  
Internal Carotid ◽  
Mechanical Thrombectomy ◽  
Intravenous Thrombolysis ◽  
Tissue Type ◽  
Extracranial Internal Carotid Artery ◽  
Anterior Circulation

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.

Abstract WP20: Efficacy and Safety of Mechanical Thrombectomy in Emergent Large Vessel Occlusions with Concomitant Cervical Internal Carotid Artery Occlusion

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Nitin Goyal ◽  
Georgios Tsivgoulis ◽  
Abhi Pandhi ◽  
Yasser M Khorchid ◽  
Abhishek Ojha ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Mechanical Thrombectomy ◽  
Large Vessel ◽  
Efficacy And Safety ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Aspiration Thrombectomy ◽  
Cervical Internal Carotid Artery

Introduction: Recently, five published major randomized controlled clinical trials have demonstrated that timely mechanical thrombectomy (MT) of acute ischemic strokes (AIS) with emergent large vessel occlusion (ELVO) is safe and improves functional outcomes. However, data evaluating the efficacy and safety of MT in ELVO patients with concomitant cervical internal carotid artery (cICA) occlusion is limited. The purpose of this study is to evaluate efficacy and safety of MT in ELVO patients with concomitant cICA occlusion Methods: We prospectively analyzed consecutive AIS patients with anterior circulation ELVO who underwent stent-retriever or primary aspiration thrombectomy at two tertiary stroke centers. Outcome measures in our study were 3-month mortality and modified ranking scale (mRS), as well as symptomatic intracranial hemorrhage (sICH). Safety and efficacy outcomes were compared between ELVO patients with and without concomitant cICA occlusion. Results: A total of 137 AIS patients had anterior circulation ELVO and underwent MT (age 63 ± 14, 49% male, median NIHSS 17, IQR [13-20]). ELVO patients with concomitant cICA occlusion (n=19) did not differ in terms of rates of sICH (0% versus 11%, p=0.21), complete recanalization (68 % versus 68%, p=1.00), onset to groin puncture time (minutes [IQR] 268 [211-379] versus 225 [165-312], p=0.47), 3-month mortality (35% versus 26 %, p=0.55), and mRS of 0-2 at 3 months (41% versus 45%, p=0.80) when compared with ELVO patients without concomitant cICA occlusion (n=118). Admission NIHSS was higher among ELVO patients with concomitant cICA occlusion (median [IQR], 18 [15-22] versus 16 [12-19], p=0.01), and they tended to have higher groin puncture to recanalization time (minutes [IQR] 74 [42-97] versus 49 [38-78], p=0.09). The ordinal shift analysis did not show any difference in favorable outcomes in two groups in unadjusted analyses or after adjustment for admission NIHSS and groin to recanalization time (common OR=0.78 [95% CI: 0.27-2.29, p=0.66]). Angioplasty was performed in 11 of 19 ELVO patients with concomitant cICA occlusion. Three patients required stent placement. Discussion: Our study indicates that MT can be performed safely and effectively in ELVO patients with concomitant cICA occlusion.

scholarly journals Day 1 Extracranial Internal Carotid Artery Patency Is Associated With Good Outcome After Mechanical Thrombectomy for Tandem Occlusion

Stroke ◽  
2018 ◽  
Vol 49 (10) ◽  
pp. 2520-2522 ◽  
Author(s):  
Nicolas Bricout ◽  
Thomas Personnic ◽  
Marc Ferrigno ◽  
Julien Labreuche ◽  
Laurent Estrade ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Mechanical Thrombectomy ◽  
Extracranial Internal Carotid Artery ◽  
Good Outcome ◽  
Tandem Occlusion

INTERNAL CAROTID ARTERY STENTING WITH SIMULTANEOUS THROMBECTOMY IN TANDEM OCCLUSION WITH ACUTE ISCHEMIC STROKE

Vestnik ◽  
2021 ◽  
pp. 126-130
Author(s):  
Р.М. Кастей ◽  
Е.К. Дюсембеков ◽  
Е.С. Жуков ◽  
С.Т. Калдыбаев ◽  
К.А. Никатов
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Cerebral Circulation ◽  
Internal Carotid ◽  
Mechanical Thrombectomy ◽  
Anterior Circulation ◽  
Tandem Occlusion ◽  
Large Vessels

Механическая тромбэктомия в настоящее время является золотым стандартом в лечении острого ишемического инсульта при окклюзии крупных сосудов передней циркуляции мозгового кровообращения. Однако проблема лечения так называемой тандемной окклюзии - это одновременная окклюзия или критический стенозэкстракраниальной части внутренней сонной артерии (ВСА) в комбинации с окклюзией крупныхвнутримозговых сосудов передней циркуляции мозгового кровообращения в настоящее времяостается актуальной. В данной статье представлен клинический случай успешного лечения тандемной окклюзии внутренней сонной артерии и средней мозговой артерии путем проведения механической тромбэктомии с одномоментным стентированием внутренней сонной артерии. Однако для разработки единого стандарта лечения тандемных окклюзийнеобходимо проведение дальнейших исследований. Mechanical thrombectomy is currently the gold standard in the treatment of acute ischemic stroke with occlusion of large vessels of the anterior circulation of cerebral circulation. However, the problem of treating the so-called tandem occlusion is simultaneous occlusion or extracranial part of the internal carotid artery (ICA) critical stenosis in combination with occlusion of large intracerebral vessels of the anterior cerebral circulation currently remains relevant. This article presents a clinical case of successful treatment of tandem occlusion of the internal carotid artery and middle cerebral artery by mechanical thrombectomy with simultaneous ICA stenting. However, further research is needed to develop a unified standard for the tandem occlusions treatment.

scholarly journals Treatment of Middle Cerebral Artery Occlusion and Internal Carotid Artery Dissection with Combined Mechanical Thrombectomy and Stenting of the Internal Carotid Artery

2013 ◽  
Vol 26 (1) ◽  
pp. 84-88 ◽  
Author(s):  
A. Wetter ◽  
Mi-Rim Shin ◽  
D. Meila ◽  
F. Brassel ◽  
M. Schlunz-Hendann
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Mechanical Thrombectomy ◽  
Intravenous Thrombolysis ◽  
Artery Dissection ◽  
Severe Stroke ◽  
The Right

We describe a case of combined mechanical thrombectomy of the right middle cerebral artery and stent angioplasty of the right internal carotid artery in a severe stroke caused by arterio-arterial embolism due to a traumatic dissection of the internal carotid artery. The patient was admitted with an NIHSS score of 19 and was discharged from hospital with a score of 2. Three months later neurological examination disclosed no pathological findings. The case demonstrates the crucial role of interventional procedures in the treatment of severe stroke where intravenous thrombolysis has little prospect of success.

scholarly journals Acute thromboses and occlusions of dual layer carotid stents in endovascular treatment of tandem occlusions

2019 ◽  
Vol 12 (1) ◽  
pp. 33-37 ◽  
Author(s):  
Johannes A R Pfaff ◽  
Christoph Maurer ◽  
Erasmia Broussalis ◽  
Hendrik Janssen ◽  
Raphael Blanc ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Neurological Outcome ◽  
Carotid Artery Stenting ◽  
Internal Carotid ◽  
Mechanical Thrombectomy ◽  
Thrombus Formation ◽  
Extracranial Internal Carotid Artery ◽  
Stent Occlusion ◽  
Significant Difference

PurposeTo evaluate the occurrence and risk factors of acute in-stent thrombosis or stent occlusion in patients with tandem occlusions receiving intracranial mechanical thrombectomy and emergent extracranial internal carotid artery stenting with a dual layer carotid stent.MethodsMulticenter retrospective data collection and analysis of stroke databases of seven comprehensive stroke centers from three European countries.ResultsOverall, 160 patients (mean (SD) age 66 (12) years; 104 men (65%); median (IQR) baseline NIHSS 14 (9–18); IV lysis, n=97 (60.6%)) were treated for a cervical carotid artery occlusion or stenosis using a CASPER stent (MicroVention), and received mechanical thrombectomy for an intracranial occlusion between April 2014 and November 2018. During the procedure or within 72 hours, formation of thrombus and complete occlusion of the CASPER stent was observed in 33/160 (20.8%) and in 12/160 patients (7.5%), respectively. In 25/33 (75.8%) and in 9/12 patients (75%), respectively, this occurred during the procedure. No statistically significant difference was observed between patients with and without thrombus formation with regard to pre-existing long term medication with anticoagulants or intraprocedural administration of heparin, acetylsalicylic acid (ASA), or heparin and ASA. Favorable early neurological outcome was similar in patients with (n=15; 45.5%) and without (n=63; 49.6%) thrombus formation at the CASPER stent.ConclusionAcute thrombosis or occlusion of CASPER stents in thrombectomy patients receiving emergent extracranial internal carotid artery stenting for tandem occlusions were observed more often during the procedure than within 72 hours of follow-up, were less frequent then previously reported, and showed no impact on early neurological outcome.

Mechanical thrombectomy with the Trevo ProVue device in ischemic stroke patients: does improved visibility translate into a clinical benefit?

2015 ◽  
Vol 8 (8) ◽  
pp. 778-782 ◽  
Author(s):  
Christoph Kabbasch ◽  
Anastasios Mpotsaris ◽  
De-Hua Chang ◽  
Sonja Hiß ◽  
Franziska Dorn ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Intravenous Thrombolysis ◽  
Outcome Data ◽  
Stent Retriever ◽  
Large Artery ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Reported Data

PurposeTo investigate the efficacy and safety of the Trevo ProVue (TPV) stent retriever in stroke patients with large artery occlusions, with particular attention to the full structural radiopacity of the TPV.Materials and methodsCase files and images of TPV treatments were reviewed for clinical and technical outcome data, including revascularization rates, device and procedure related complications, and outcome at discharge and after 90 days.Results76 patients were treated with TPV. Mean National Institutes of Health Stroke Scale (NIHSS) score was 18 and 68% had additional intravenous thrombolysis. 63 occlusions were in the anterior circulation: 44 M1 (58%), 8 M2 (11%), 8 internal carotid artery-terminus (11%), 2 internal carotid artery- left (3%), 1 A2 (1%), and 13 vertebrobasilar (17%). 58 of 76 (76%) were solely treated with TPV; the remainder were treated with additional stent retrievers. Mean number of passes in TPV only cases was 2.2 (SD 1.2). In rescue cases, 3.2 (SD 2.2) passes were attempted with the TPV followed by 2.6 rescue device passes (SD 2). TPV related adverse events occurred in 4/76 cases (5%) and procedural events in 6/76 cases (8%). Mean procedural duration was 64 min (SD 42). Thrombolysis in Cerebral Infarction (TICI) 2b/3 recanalization was achieved in 69/76 patients (91%), including 50% TICI 3. Of 56 survivors (74%), 37 (49%) showed a favorable outcome at 90 days (Solitaire With the Intention for Thrombectomy trial criteria), statistically associated with age, baseline NIHSS, onset to revascularization time, and TICI 2b–3 reperfusion. TPV radiopacity allowed for visual feedback, changing the methodology of stent retriever use in 44/76 cases (58%).ConclusionsNeurothrombectomy with TPV is feasible, effective, and safe. The recanalization rate compares favorably with reported data in the literature. Improved structural radiopacity may facilitate neurothrombectomy or influence the course of action during retrieval.

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