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
Department of Neurology, Medical University of Vienna, Wien, Austria.
Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.
J Neurointerv Surg. 2022 May;14(5). doi: 10.1136/neurintsurg-2021-017474. Epub 2021 May 4.
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.
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.
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).
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).
串联性颈内动脉闭塞的卒中患者的最佳治疗方法和预后尚不清楚。我们分析了ESCAPE-NA1试验中串联闭塞患者的结局和治疗策略。
ESCAPE-NA1是一项多中心国际随机试验，在1105例接受血管内治疗的急性缺血性卒中患者中比较了依达拉奉右莰醇与安慰剂的疗效。我们将串联闭塞定义为在导管血管造影上颈内动脉（ICA）完全闭塞，同时伴有同侧近端颅内大血管闭塞。比较了串联闭塞患者与非串联闭塞患者之间，以及接受ICA支架置入术的串联闭塞患者与未接受该手术的患者之间的基线特征和结局参数。使用多变量回归模型分析串联闭塞对功能结局的影响。
在115/1105例（10.4%）串联闭塞患者中，62例（53.9%）接受了颈内动脉闭塞的支架置入术。其中，46例（74.2%）在颅内血栓切除术之后进行了支架置入，16例（25.8%）在颅内血栓切除术之前进行了支架置入。115例串联闭塞患者中有82例（71.3%）在90天时改良Rankin量表（mRS）评分为0-2，而981例非串联闭塞患者中有579例（59.5%）达到该评分。在调整分析中，串联闭塞并未影响功能结局（比值比1.5，95%置信区间0.95至2.4）。在串联闭塞患者亚组中，与未进行支架置入相比，颈内动脉支架置入与不同结局无关（mRS 0-2：75.8%对66.0%，调整后比值比2.0，95%置信区间0.8至5.1）。
在我们的研究中，急性大血管卒中患者的串联性颈内动脉闭塞并未降低获得良好功能结局的几率。无论颈内动脉闭塞的处理方式是（支架置入术与否），功能结局均相似。
