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Management and outcome of patients with acute ischemic stroke and tandem carotid occlusion in the ESCAPE-NA1 trial.
Marko, Martha; Cimflova, Petra; Poppe, Alexandre Y; Kashani, Nima; Singh, Nishita; Ospel, Johanna; Mayank, Arnuv; van Adel, Brian; McTaggart, Ryan A; Nogueira, Raul G; Demchuk, Andrew M; Rempel, Jeremy L; Joshi, Manish; Zerna, Charlotte; Menon, Bijoy K; Tymianski, Michael; Hill, Michael D; Goyal, Mayank; Almekhlafi, Mohammed A.
Afiliación
  • Marko M; Department of Neurology, Medical University of Vienna, Wien, Austria.
  • Cimflova P; Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.
  • Poppe AY; Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
  • Kashani N; Department of Neurosciences, Université de Montréal, Montreal, Québec, Canada.
  • Singh N; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada.
  • Ospel J; Neuroradiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.
  • Mayank A; Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada.
  • van Adel B; Department of Radiology, University Hospital Basel, Basel, Switzerland.
  • McTaggart RA; University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.
  • Nogueira RG; Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
  • Demchuk AM; Neurosurgery, McMaster University Department of Medicine, Hamilton, Ontario, Canada.
  • Rempel JL; Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA.
  • Joshi M; Emory University School of Medicine, Grady Memorial Hospital Corp, Atlanta, Georgia, USA.
  • Zerna C; Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.
  • Menon BK; Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada.
  • Tymianski M; Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada.
  • Hill MD; Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.
  • Goyal M; Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.
  • Almekhlafi MA; NoNO, Toronto, Ontario, Canada.
J Neurointerv Surg ; 14(5)2022 May.
Article en En | MEDLINE | ID: mdl-33947770
BACKGROUND: The optimal treatment and prognosis for stroke patients with tandem cervical carotid occlusion are unclear. We analyzed outcomes and treatment strategies of tandem occlusion patients in the ESCAPE-NA1 trial. METHODS: ESCAPE-NA1 was a multicenter international randomized trial of nerinetide versus placebo in 1105 patients with acute ischemic stroke who underwent endovascular treatment. We defined tandem occlusions as complete occlusion of the cervical internal carotid artery (ICA) on catheter angiography, in addition to a proximal ipsilateral intracranial large vessel occlusion. Baseline characteristics and outcome parameters were compared between patients with tandem occlusions versus those without, and between patients with tandem occlusion who underwent ICA stenting versus those who did not. The influence of tandem occlusions on functional outcome was analyzed using multivariable regression modeling. RESULTS: Among 115/1105 patients (10.4%) with tandem occlusions, 62 (53.9%) received stenting for the cervical ICA occlusion. Of these, 46 (74.2%) were stented after and 16 (25.8%) before the intracranial thrombectomy. A modified Rankin Score (mRS) of 0-2 at 90 days was achieved in 82/115 patients (71.3%) with tandem occlusions compared with 579/981 (59.5%) patients without tandem occlusions. Tandem occlusion did not impact functional outcome in the adjusted analysis (OR 1.5, 95% CI 0.95 to 2.4). Among the subgroup of patients with tandem occlusion, cervical carotid stenting was not associated with different outcomes compared with no stenting (mRS 0-2: 75.8% vs 66.0%, adjusted OR 2.0, 95% CI 0.8 to 5.1). CONCLUSIONS: Tandem cervical carotid occlusion in patients with acute large vessel stroke did not lower the odds of good functional outcome in our study. Functional outcomes were similar irrespective of the management of the cervical ICA occlusion (stenting vs not stenting).
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Estenosis Carotídea / Accidente Cerebrovascular / Procedimientos Endovasculares / Accidente Cerebrovascular Isquémico Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: J Neurointerv Surg Año: 2022 Tipo del documento: Article País de afiliación: Austria Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Estenosis Carotídea / Accidente Cerebrovascular / Procedimientos Endovasculares / Accidente Cerebrovascular Isquémico Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: J Neurointerv Surg Año: 2022 Tipo del documento: Article País de afiliación: Austria Pais de publicación: Reino Unido