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Cervical Dissection in Patients With Tandem Lesions Is Associated With Distal Embolism and Lower Recanalization Success.
Galecio-Castillo, Milagros; Guerrero, Waldo R; Hassan, Ameer E; Farooqui, Mudassir; Jumaa, Mouhammad A; Divani, Afshin A; Abraham, Michael G; Petersen, Nils H; Fifi, Johanna T; Malik, Amer M; Siegler, James E; Nguyen, Thanh N; Sheth, Sunil A; Yoo, Albert J; Linares, Guillermo; Janjua, Nazli; Quispe-Orozco, Darko; Olivé-Gadea, Marta; Tekle, Wondwossen G; Zaidi, Syed F; Sabbagh, Sara Y; Barkley, Tiffany; Prasad, Ayush; De Leacy, Reade A; Abdalkader, Mohamad; Salazar-Marioni, Sergio; Soomro, Jazba; Gordon, Weston; Turabova, Charoskhon; Rodriguez-Calienes, Aaron; Dibas, Mahmoud; Mokin, Maxim; Yavagal, Dileep R; Ribo, Marc; Jovin, Tudor G; Ortega-Gutierrez, Santiago.
Afiliación
  • Galecio-Castillo M; Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City (M.G.-C., M.F., D.Q.-O., A.R.-C., M.D., S.O.-G.).
  • Guerrero WR; Department of Neurology and Brain Repair, University of South Florida, Tampa (W.R.G., M.M.).
  • Hassan AE; Department of Neurology, Valley Baptist Medical Center/University of Texas Rio Grande Valley, Harlingen (A.E.H., W.G.T.).
  • Farooqui M; Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City (M.G.-C., M.F., D.Q.-O., A.R.-C., M.D., S.O.-G.).
  • Jumaa MA; Department of Neurology, ProMedica Toledo Hospital, OH (M.A.J., S.F.Z.).
  • Divani AA; Department of Neurology, University of New Mexico Health Science Center, Albuquerque (A.A.D., S.Y.S.).
  • Abraham MG; Department of Neurology, University of Kansas Medical Center (M. Abraham, T.B.).
  • Petersen NH; Department of Neurology, Yale University School of Medicine, New Haven, CT (N.H.P., A.P.).
  • Fifi JT; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.F., R.D.L.).
  • Malik AM; Department of Neurology, University of Miami Miller School of Medicine, FL (A.M.M., D.R.Y.).
  • Siegler JE; Cooper Neurological Institute, Cooper University Hospital, Camden, NJ (J.E.S., T.G.J.).
  • Nguyen TN; Cooper Medical School of Rowan University, Candem, NJ (J.E.S., T.G.J.).
  • Sheth SA; Department of Neurology, Boston Medical Center, MA (T.N.N., M. Abdalkader).
  • Yoo AJ; Department of Neurology, UT Health McGovern Medical School, Houston, TX (S.S., S.S.-M.).
  • Linares G; Texas Stroke Institute, Dallas-Fort Worth (A.J.Y., J.S.).
  • Janjua N; Department of Neurology, Saint Louis University, St. Louis, MO (G.L., W.G.).
  • Quispe-Orozco D; Asia Pacific Comprehensive Stroke Institute, Pomona Valley Hospital Medical Center, CA (N.J., C.T.).
  • Olivé-Gadea M; Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City (M.G.-C., M.F., D.Q.-O., A.R.-C., M.D., S.O.-G.).
  • Tekle WG; Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain (M.O.-G., M.R.).
  • Zaidi SF; Department of Neurology, Valley Baptist Medical Center/University of Texas Rio Grande Valley, Harlingen (A.E.H., W.G.T.).
  • Sabbagh SY; Department of Neurology, ProMedica Toledo Hospital, OH (M.A.J., S.F.Z.).
  • Barkley T; Department of Neurology, University of New Mexico Health Science Center, Albuquerque (A.A.D., S.Y.S.).
  • Prasad A; Department of Neurology, University of Kansas Medical Center (M. Abraham, T.B.).
  • De Leacy RA; Department of Neurology, Yale University School of Medicine, New Haven, CT (N.H.P., A.P.).
  • Abdalkader M; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY (J.F., R.D.L.).
  • Salazar-Marioni S; Department of Neurology, Boston Medical Center, MA (T.N.N., M. Abdalkader).
  • Soomro J; Department of Neurology, UT Health McGovern Medical School, Houston, TX (S.S., S.S.-M.).
  • Gordon W; Texas Stroke Institute, Dallas-Fort Worth (A.J.Y., J.S.).
  • Turabova C; Department of Neurology, Saint Louis University, St. Louis, MO (G.L., W.G.).
  • Rodriguez-Calienes A; Asia Pacific Comprehensive Stroke Institute, Pomona Valley Hospital Medical Center, CA (N.J., C.T.).
  • Dibas M; Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City (M.G.-C., M.F., D.Q.-O., A.R.-C., M.D., S.O.-G.).
  • Mokin M; Neuroscience, Clinical Effectiveness and Public Health Research Group, Universidad Científica del Sur, Lima, Peru (A.R.-C.).
  • Yavagal DR; Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City (M.G.-C., M.F., D.Q.-O., A.R.-C., M.D., S.O.-G.).
  • Ribo M; Department of Neurology and Brain Repair, University of South Florida, Tampa (W.R.G., M.M.).
  • Jovin TG; Department of Neurology, University of Miami Miller School of Medicine, FL (A.M.M., D.R.Y.).
  • Ortega-Gutierrez S; Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain (M.O.-G., M.R.).
Stroke ; 55(7): 1808-1817, 2024 Jul.
Article en En | MEDLINE | ID: mdl-38913799
ABSTRACT

BACKGROUND:

Tandem lesions consist of cervical internal carotid artery (ICA) stenosis or occlusion, most commonly of atherosclerosis or dissection etiology, plus a large vessel occlusion. In this study, we compare outcomes in patients with atherosclerosis versus dissection of the cervical ICA.

METHODS:

This multicenter retrospective cohort study includes data from tandem lesion patients who underwent endovascular treatment from 2015 to 2020. Atherosclerosis was defined as ICA stenosis/occlusion associated with a calcified lesion and dissection by the presence of a tapered or flame-shaped lesion and intramural hematoma. Primary

outcome:

90-day functional independence (modified Rankin Scale score, 0-2); secondary

outcomes:

90-day favorable shift in the modified Rankin Scale score, modified Thrombolysis in Cerebral Infarction score 2b-3, modified Thrombolysis in Cerebral Infarction score 2c-3, symptomatic intracranial hemorrhage, parenchymal hematoma type 2, petechial hemorrhage, distal embolization, early neurological improvement, and mortality. Analysis was performed with matching by inverse probability of treatment weighting.

RESULTS:

We included 526 patients (68 [59-76] years; 31% females); 11.2% presented dissection and 88.8%, atherosclerosis. Patients with dissection were younger, had lower rates of hypertension, hyperlipidemia, diabetes, and smoking history. They also exhibited higher rates of ICA occlusion, multiple stents (>1), and lower rates of carotid self-expanding stents. After matching and adjusting for covariates, there were no differences in 90-day functional independence. The rate of successful recanalization was significantly lower in the dissection group (adjusted odds ratio, 0.38 [95% CI, 0.16-0.91]; P=0.031), which also had significantly higher rates of distal emboli (adjusted odds ratio, 2.53 [95% CI, 1.15-5.55]; P=0.021). There were no differences in other outcomes. Acute ICA stenting seemed to increase the effect of atherosclerosis in successful recanalization.

CONCLUSIONS:

This study reveals that among patients with acute stroke with tandem lesions, cervical ICA dissection is associated with higher rates of distal embolism and lower rates of successful recanalization than atherosclerotic lesions. Using techniques to minimize the risk of distal embolism may mitigate this contrast. Further prospective randomized trials are warranted to fully understand these associations.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Procedimientos Endovasculares Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Stroke Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Procedimientos Endovasculares Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Stroke Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos