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

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.

• Authors: Adrien Ter Schiphorst, Roxane Peres, Cyril Dargazanli, Raphaël Blanc, Benjamin Gory, Sébastien Richard, Gaultier Marnat, Igor Sibon, Benoit Guillon, Romain Bourcier, Christian Denier, Laurent Spelle, Julien Labreuche, Arturo Consoli, Bertrand Lapergue, Vincent Costalat, Michael Obadia, Caroline Arquizan, ETIS Registry Investigators
• Journal: Journal of neurology (J Neurol) Vol. 269 Issue 8 Pg. 4383-4395 (Aug 2022) ISSN: 1432-1459 [Electronic] Germany
• PMID: 35357557 (Publication Type: Journal Article)
• Copyright: © 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

Topics

• Aged
• Brain Ischemia (diagnostic imaging, surgery)
• Carotid Artery Diseases (etiology)
• Carotid Artery, Internal (diagnostic imaging, surgery)
• Data Analysis
• Endovascular Procedures (adverse effects)
• Humans
• Ischemic Stroke
• Registries
• Stroke (diagnostic imaging, etiology, surgery)
• Thrombectomy (methods)
• Thrombosis (complications)
• Treatment Outcome