Etiologic and prognostic value of external carotid artery thrombus detection during endovascular therapy for anterior circulation proximal occlusions
Autor: | Thomas Courret, Thomas Tourdias, Jean Papaxanthos, Julien Labreuche, Florent Gariel, Jean‐Sebastien Liegey, Stephane Olindo, Pauline Renou, Jerome Berge, Xavier Barreau, Sharmila Sagnier, Patrice Menegon, Ludovic Lucas, Pierre Briau, Mathilde Poli, Sabrina Debruxelles, François Rouanet, Vincent Dousset, Igor Sibon, Gaultier Marnat |
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Rok vydání: | 2022 |
Předmět: | |
Zdroj: | European Journal of Neurology. 30:380-388 |
ISSN: | 1468-1331 1351-5101 |
Popis: | An early understanding of stroke mechanism may improve treatment and outcome in patients presenting with large vessel occlusion stroke (LVOS) treated with mechanical thrombectomy (MT). We aimed to investigate whether spontaneous external carotid artery (ECA) embolism detection during MT is associated with stroke etiology and clinical outcome.We retrospectively reviewed our prospectively maintained institutional database including consecutive patients with anterior circulation LVOS treated with MT between January 2015 and August 2020.An ECA embolus was detected in 68 of 1298 patients (5.2%). The kappa coefficient for interobserver agreement was 0.89 (95% confidence interval [CI] 0.82-0.95). ECA embolism was significantly associated with intracranial internal carotid artery (ICA) occlusion (p 0.001), cardioembolic etiology (p 0.001) and a lower clot burden score (p 0.001). Day-1 variation of National Institutes of Health Stroke Scale score (adjusted odds ratio [OR] -2.7, 95% CI -4.9 to 0.3; p = 0.021) and delta Alberta Stroke Program Early Computed Tomography Score (adjusted OR 0.9, 95% CI 0.2 to 1.5; p = 0.004) were worse among patients with ECA emboli. There was no significant difference in 90-day functional outcome between groups (adjusted OR 0.8, 95% CI 0.42 to 1.52; p = 0.50).In patients with anterior circulation LVOS treated with MT, ECA embolism was significantly associated with cardioembolic etiology, high thrombus burden and proximal intracranial ICA occlusions. This underexplored angiographic pattern might provide a valuable etiologic clue to the underlying cause of anterior circulation LVOS and may also help determine the appropriate revascularization strategy. |
Databáze: | OpenAIRE |
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