Abstract
Background and aims
Emergent carotid artery stenting (eCAS) is increasingly used in patients with acute ischemic stroke due to tandem occlusion. However, utility of eCAS in tandem occlusion cases due to carotid dissection (TOCD) remains unclear. This study compared the effectiveness of eCAS in patients with TOCD versus other causes.
Methods
We conducted a multicenter registry study including patients with acute stroke treated with eCAS between 2019-2023. Collected data included demographics, stroke severity, procedural details, successful recanalization (mTICI 2c-3), technical failure (ICA occlusion/ stenosis>50% at 48h), symptomatic intracerebral hemorrhage (sICH) and good functional status at 3 months (mRS 0-2). Patients were divided into two groups: TOCD and tandem occlusion due to other causes (TOOC).
Results
309 patients were included: 33 had TOCD and 276 TOOC. The TOCD group were younger, had fewer vascular risk factors, were more frequently treated with dual antiplatelet therapy during the procedure and had longer, narrower stents. mTICI2c-3 was achieved in 74% of TOCD patients and 67% of TOOC (p=0.478), technical failure occurred in 26.7% and 13.7% respectively (p=0.06). Eighteen patients suffered sICH (5.8%), 6.1% in the TOCD and 5.8% in TOOC group, p=0.955. Good functional outcome at 3 months was achieved in 55% of patients (TOCD: 79%, TOOC: 52%, p=0.007, adjusted OR (age, baseline NIHSS and ASPECTS and iv thrombolysis) 2.2 (95%CI 0.7 – 6.3), p=0.16.8
Conclusions
In this study, eCAS in patients with TOCD wasn’t associated with significant differences in recanalization success, sICH or functional outcome compared to TOOC. However, a trend towards higher technical failure was noted.
Conflict of interest
Nothing to disclose