Journal article
Emergent Carotid Stenting During Thrombectomy in Tandem Occlusions Secondary to Dissection: A STOP-CAD Secondary Study
Stroke (1970), Vol.56(4), pp.808-817
04/2025
DOI: 10.1161/STROKEAHA.124.048295
PMID: 39882629
Abstract
The optimal endovascular management of cervical carotid dissection causing tandem occlusion remains uncertain. We investigated the impact of emergent carotid stenting during endovascular treatment (EVT) for acute ischemic stroke (AIS) in patients with tandem occlusion secondary to cervical carotid artery dissection.
This was a secondary analysis of patients treated with EVT for AIS due to occlusive carotid artery dissection and tandem occlusion included in the retrospective international Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection (STOP-CAD) study. We compared patients with and without emergent stenting. The primary efficacy and safety outcomes were 90-day functional independence (modified Rankin Scale 0-2) and symptomatic intracranial hemorrhage (sICH) within 24h after EVT. Procedural outcome was successful intracranial recanalization (mTICI 2b/3). We used mixed-effect logistic regression adjusting for site, age, and NIHSS. In additional analyses, we used inverse probability of treatment weighting and adjusted for ASPECTS.
Of the 4023 patients enrolled in STOP-CAD, 328 presented with anterior circulation AIS due to tandem occlusion and underwent EVT. The median age was 51 years (interquartile range 44-58), and 96 patients (29.3%) were female. One hundred fifty patients (45.7%) underwent emergent stenting. There was no significant association between stenting and 90-day functional independence (62.0% vs 59.7%; aOR 1.23, 95% CI 0.82-1.86, p=0.315) or sICH (7.3% vs 7.9%; aOR OR 0.95, 95% CI 0.41-2.2, p=0.913). Emergent carotid stenting was associated with successful intracranial recanalization (81.8% vs 76.6% aOR 2.62, 95% CI 1.52-4.5, p<0.001). Results did not meaningfully change in additional analyses.
In patients presenting with an acute anterior circulation tandem occlusion secondary to cervical carotid artery dissection, emergent stenting was associated with a higher likelihood of successful intracranial recanalization but not improved functional outcomes or increased sICH. It remains unclear whether emergent stenting led to successful intracranial recanalization or patients with successful intracranial recanalization were more likely to be stented. Randomized trials are warranted.
Details
- Title: Subtitle
- Emergent Carotid Stenting During Thrombectomy in Tandem Occlusions Secondary to Dissection: A STOP-CAD Secondary Study
- Creators
- João André Sousa - Hospitais da Universidade de CoimbraMarc Rodrigo-Gisbert - Universitat Autònoma de BarcelonaLiqi Shu - Brown UniversityAnqi Luo - The University of Texas at San Antonio Health Science CenterHan Xiao - University of California, Santa BarbaraNoor A Mahmoud - University of OklahomaAsghar Shah - Brown UniversityAna Luyza Oliveira Santos - University of OklahomaMarina Moore - The University of Texas at AustinDaniel M Mandel - West Virginia UniversityMirjam R Heldner - University Hospital of BernVasco Barata - Hospitais da Universidade de CoimbraSara Bernardo-Castro - Hospitais da Universidade de CoimbraNils Henninger - University of Massachusetts Chan Medical SchoolJayachandra Muppa - University of Massachusetts Chan Medical SchoolMarcel Arnold - University Hospital of BernAhmad Nehme - Université de Caen NormandieAaron Rothstein - University of PennsylvaniaOssama Khazaal - University of PennsylvaniaJosefin E Kaufmann - University Hospital of BaselStefan T Engelter - University Hospital of BaselChristopher Traenka - University Hospital of BaselIssa Metanis - Hadassah Medical CenterRonen R Leker - Hadassah Medical CenterChristian H Nolte - Charité - Universitätsmedizin BerlinMalik Ghannam - University of IowaEdgar A Samaniego - University of IowaMohammad AlMajali - University of IowaAlexandre Y Poppe - Centre Hospitalier de l’Université de MontréalMichele Romoli - Ospedale “M. Bufalini” di CesenaJennifer A Frontera - New York University Langone Orthopedic HospitalMarialuisa Zedde - Azienda Sanitaria Unità Locale di Reggio EmiliaWayneho Kam - Rex HospitalBrian Mac Grory - Duke UniversityFaddi Ghassan Saleh Velez - University of Oklahoma Health Sciences CenterTamra Ranasinghe - Mayo Clinic in FloridaJames E Siegler - University of ChicagoAdeel S Zubair - Yale UniversityJoão Pedro Marto - Hospital de Egas MonizPiers Klein - Boston UniversityThanh N Nguyen - Boston UniversityMohamad Abdalkader - Boston UniversityGabriel Paulo Mantovani - Hospital de Clínicas de Porto AlegreAlexis N Simpkins - Cedars-Sinai Medical CenterShayak Sen - Cedars-Sinai Medical CenterMarwa Elnazeir - University of LouisvilleShadi Yaghi - Brown UniversityJoao Sargento-Freitas - Hospitais da Universidade de CoimbraManuel Requena - Universitat Autònoma de Barcelona
- Resource Type
- Journal article
- Publication Details
- Stroke (1970), Vol.56(4), pp.808-817
- DOI
- 10.1161/STROKEAHA.124.048295
- PMID
- 39882629
- NLM abbreviation
- Stroke
- ISSN
- 1524-4628
- eISSN
- 1524-4628
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Language
- English
- Electronic publication date
- 01/30/2025
- Date published
- 04/2025
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984781275002771
Metrics
9 Record Views