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Carotid artery angioplasty versus stenting for management of acute tandem occlusions
Journal article   Peer reviewed

Carotid artery angioplasty versus stenting for management of acute tandem occlusions

Aayushi Garg, Mudassir Farooqui, Cynthia B. Zevallos, Darko Quispe-Orozco, Alan Mendez-Ruiz, Osama Zaidat and Santiago Ortega-Gutierrez
Journal of the neurological sciences, Vol.428, pp.117588-117588
09/15/2021
DOI: 10.1016/j.jns.2021.117588
PMID: 34403954

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Abstract

Background The optimal approach to treat the cervical carotid artery lesion during endovascular thrombectomy (EVT) for acute strokes with tandem occlusions is unclear. While carotid artery stenting (CAS) might be a more definitive recanalization method, the potential risk of intracranial hemorrhage (ICH) limits its routine usage. In this study, we aimed to evaluate the safety outcomes of CAS and carotid artery angioplasty (CAA) in patients with acute tandem occlusions. Methods In this retrospective cohort study, data were obtained from the Nationwide Readmissions Database 2016–2017. The primary safety outcome was a composite of ICH and all-cause in-hospital mortality. Logistic regression analysis was used to compare the in-hospital outcomes. Survival analysis was used to estimate the 30-day readmissions. Results We identified 2042 hospitalizations meeting the study inclusion criteria (median age: 66 years, female 31.3%). Of these, 1391 (68.1%) had undergone CAS and 651 (31.9%) CAA alone. Baseline characteristics between the two groups were similar, except patients with CAS were more likely to be on anti-thrombotic medications and were less likely to have received intravenous thrombolysis. There was no significant difference in the clinical outcomes including ICH, in-hospital mortality, gastrostomy tube placement, prolonged mechanical ventilation, length of stay, hospital charges, and 30-day readmissions between the two groups, however, patients with CAS were more likely to be discharged home after adjusting for the confounding variables [odds ratio (OR) 1.49, 95% confidence interval (CI) 1.05–2.12, P 0.025]. Conclusion The emergent CAS-EVT approach appears to be safe with no adverse outcomes compared to CAA alone. •Acute carotid artery intervention in tandem occlusions involves stenting in most (68%) cases.•Carotid artery angioplasty and stenting for acute tandem occlusions have similar safety profile for in-hospital outcomes.•Patients with carotid artery stenting are more likely to be discharged home as compared to those with angioplasty alone.
 Carotid artery stenting Carotid endarterectomy Carotid occlusive disease Mechanical thrombectomy Nationwide readmissions database

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