| Autor: |
Jadhav AP; From the Department of Neurology, University of Pittsburgh Medical Center, PA (A.P.J., T.G.J.)., Zaidat OO; St Vincent Mercy Hospital, Toledo, OH (O.O.Z.)., Liebeskind DS; Department of Neurology (D.S.L,).; University of California Los Angeles (D.S.L., R.J., V.S.)., Yavagal DR; Department of Neurological Surgery, University of Miami Miller School of Medicine/Jackson Memorial Hospital, FL (D.R.Y.)., Haussen DC; Department of Neurology, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA (D.C.H., R.G.N.)., Hellinger FR Jr; Department of Radiology, Florida Hospital Neuroscience Institute, Winter Park (F.R.H.)., Jahan R; Department of Radiology, David Geffen School of Medicine (R.J., V.S.).; University of California Los Angeles (D.S.L., R.J., V.S.)., Jumaa MA; Department of Neurology, Promedica Toledo Hospital, OH (M.A.J.)., Szeder V; Department of Radiology, David Geffen School of Medicine (R.J., V.S.).; University of California Los Angeles (D.S.L., R.J., V.S.)., Nogueira RG; Department of Neurology, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA (D.C.H., R.G.N.)., Jovin TG; From the Department of Neurology, University of Pittsburgh Medical Center, PA (A.P.J., T.G.J.). |
| Abstrakt: |
Background and Purpose- Although intracranial thrombectomy represents the standard treatment approach for anterior circulation tandem occlusions, whether the extracranial lesion requires acute stenting remains unclear. Our aim was to investigate differences in clinical and procedural outcomes related to stenting extracranial lesions in a registry of patients undergoing thrombectomy for acute stroke. Methods- Data were analyzed from the STRATIS registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke)-a prospective, nonrandomized study of patients undergoing neurothrombectomy with the Solitaire device. A total of 984 patients treated at 55 sites were analyzed. Univariate and multivariable logistic regression was used to assess relationship between outcome and procedural technique. Results- Of 147 (14.9%) patients with tandem lesions treated, stenting of the extracranial lesion during thrombectomy was performed in 80 patients and withheld in 67 patients. There were no differences between groups with respect to age, ASPECTS (Alberta Stroke Program Early CT Score), or intravenous-tPA (tissue-type plasminogen activator) use. However, the patients in the stenting group had lower baseline National Institutes of Health Stroke Scale (16 versus 17.9; P=0.07), shorter onset to arterial puncture time (133.6 versus 163.4 minutes; P=0.04), and lower rates of atrial fibrillation (6.3% versus 25.4%) as compared to the nonstenting group. Good outcomes (modified Rankin Scale, 0-2 at 90 days) were higher in the stenting group (68.5% versus 42.2%; P=0.003) with no difference in mortality or symptomatic hemorrhage. After adjustment for covariates, stenting continued to be associated with superior outcomes. Conclusions- Acute stenting of an extracranial carotid stenosis during neurothrombectomy can be achieved with equal safety compared with no stenting. Carotid stenting in the acute phase may lead to better outcomes; this should ideally be confirmed by randomized trials. |
