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Cited 12 time in webofscience Cited 18 time in scopus
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Carotid Artery Stenting and Intracranial Thrombectomy for Tandem Cervical and Intracranial Artery Occlusions

Authors
Kim, ByungjunKim, Byung MoonBang, Oh YoungBaek, Jang-HyunHeo, Ji HoeNam, Hyo SukKim, Young DaeYoo, JoonsangKim, Dong JoonJeon, PyoungBaik, Seung KugSuh, Sang HyunLee, Kyung-YulKwak, Hyo SungRoh, Hong GeeLee, Young-JunKim, Sang HeumRyu, Chang WooIhn, Yon-KwonJeon, Hong-JunKim, Jin WooByun, Jun SooSuh, Sang IlPark, Jeong JinLee, Woong JaeRoh, JieunShin, Byoung-soo
Issue Date
Feb-2020
Publisher
OXFORD UNIV PRESS INC
Keywords
Acute stroke; Carotid arteries; Stent; Thrombectomy
Citation
Neurosurgery, v.86, no.2, pp 213 - 220
Pages
8
Indexed
SCIE
SCOPUS
Journal Title
Neurosurgery
Volume
86
Number
2
Start Page
213
End Page
220
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/1066
DOI
10.1093/neuros/nyz026
ISSN
0148-396X
1524-4040
Abstract
BACKGROUND It remains controversial whether carotid artery stenting (CAS) is needed in cases of tandem cervical internal carotid artery occlusion (cICAO) and intracranial large vessel occlusion (LVO). OBJECTIVE To investigate the efficacy and safety of CAS in combination with endovascular thrombectomy (CAS-EVT) in cICAO-LVO patients and to compare its outcomes with those of EVT without CAS (EVT-alone). METHODS We identified all patients who underwent EVT for tandem cICAO-LVO from the prospectively maintained registries of 17 stroke centers. Patients were classified into 2 groups: CAS-EVT and EVT-alone. Clinical characteristics and procedural and clinical outcomes were compared between 2 groups. We tested whether CAS-EVT strategy was independently associated with recanalization success. RESULTS Of the 955 patients who underwent EVT, 75 patients (7.9%) had cICAO-LVO. Fifty-six patients underwent CAS-EVT (74.6%), and the remaining 19 patients underwent EVT-alone (25.4%). The recanalization (94.6% vs 63.2%, P = .002) and good outcome rates (64.3% vs 26.3%, P = .007) were significantly higher in the CAS-EVT than in the EVT-alone. Mortality was significantly lower in the CAS-EVT (7.1% vs 21.6%, P = .014). There was no significant difference in the rate of symptomatic intracranial hemorrhage between 2 groups (10.7 vs 15.8%; P = .684) and according to the use of glycoprotein IIb/IIIa inhibitor (10.0% vs 12.3%; P = .999) or antiplatelet medications (10.2% vs 18.8%; P = .392). CAS-EVT strategy remained independently associated with recanalization success (odds ratio: 24.844; 95% confidence interval: 1.445-427.187). CONCLUSION CAS-EVT strategy seemed to be effective and safe in cases of tandem cICAO-LVO. CAS-EVT strategy was associated with recanalization success, resulting in better clinical outcome.
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Kim, Byung jun
Anam Hospital (Department of Radiology, Anam Hospital)
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