Sousa João André, Rodrigo-Gisbert Marc, Shu Liqi, Luo Anqi, Xiao Han, Mahmoud Noor A, Shah Asghar, Oliveira Santos Ana Luyza, Moore Marina, Mandel Daniel M, Heldner Mirjam R, Barata Vasco, Bernardo-Castro Sara, Henninger Nils, Muppa Jayachandra, Arnold Marcel, Nehme Ahmad, Rothstein Aaron, Khazaal Ossama, Kaufmann Josefin E, Engelter Stefan T, Traenka Christopher, Metanis Issa, Leker Ronen R, Nolte Christian H, Ghannam Malik, Samaniego Edgar A, Almajali Mohammad, Poppe Alexandre Y, Romoli Michele, Frontera Jennifer, Zedde Marialuisa, Kam Wayneho, Mac Grory Brian, Saleh Velez Faddi, Ranasinghe Tamra, Siegler James E, Zubair Adeel, Marto João Pedro, Klein Piers, Nguyen Thanh N, Abdalkader Mohamad, Mantovani Gabriel, Simpkins Alexis N, Sen Shayak, Elnazeir Marwa, Yaghi Shadi, Sargento-Freitas Joao, Requena Manuel
Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Unidade Local de Saúde de Coimbra, Portugal (J.A.S., V.B., S.B.-C., J.S.-F.).
Department of Neurology, University Hospital Vall d'Hebron, Barcelona, Spain (M.R.-G., M. Requena).
Stroke. 2025 Apr;56(4):808-817. doi: 10.1161/STROKEAHA.124.048295. Epub 2025 Jan 30.
The optimal endovascular management of cervical carotid dissection causing tandem occlusion remains uncertain. We investigated the impact of emergent carotid stenting during endovascular treatment for acute ischemic stroke in patients with tandem occlusion secondary to cervical carotid artery dissection.
This was a secondary analysis of patients treated with endovascular treatment for acute ischemic stroke due to occlusive carotid artery dissection and tandem occlusion included in the retrospective international STOP-CAD study (Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection). We compared patients with and without emergent stenting. The primary efficacy and safety outcomes were 90-day functional independence (modified Rankin Scale score, 0-2) and symptomatic intracranial hemorrhage within 24 hours after endovascular treatment. Procedural outcome was successful intracranial recanalization (modified Thrombolysis in Cerebral Infarction score of 2b/3). We used mixed-effects logistic regression adjusting for site, age, and National Institutes of Health Stroke Scale. In additional analyses, we used inverse probability of treatment weighting and adjusted for Alberta Stroke Program Early CT Score.
Of the 4023 patients enrolled in STOP-CAD, 328 presented with anterior circulation acute ischemic stroke due to tandem occlusion and underwent endovascular treatment. The median age was 51 (interquartile range, 44-58) years, 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% versus 59.7%; adjusted odds ratio, 1.23 [95% CI, 0.82-1.86]; =0.315) or symptomatic intracranial hemorrhage (7.3% versus 7.9%; adjusted odds ratio, 0.95 [95% CI, 0.41-2.2]; =0.913). Emergent carotid stenting was associated with successful intracranial recanalization (81.8% versus 76.6%; adjusted odds ratio, 2.62 [95% CI, 1.52-4.5]; <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 symptomatic intracranial hemorrhage. 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.
对于导致串联闭塞的颈段颈动脉夹层，最佳的血管内治疗方案仍不明确。我们研究了在血管内治疗急性缺血性卒中时，对因颈段颈动脉夹层继发串联闭塞的患者进行急诊颈动脉支架置入术的影响。
这是一项对因闭塞性颈动脉夹层和串联闭塞接受急性缺血性卒中血管内治疗的患者进行的二次分析，这些患者纳入了回顾性国际STOP-CAD研究（颈段动脉夹层卒中预防的抗栓治疗）。我们比较了接受和未接受急诊支架置入术的患者。主要疗效和安全性结局为90天功能独立（改良Rankin量表评分，0-2）和血管内治疗后24小时内有症状性颅内出血。手术结局为成功的颅内再通（改良脑梗死溶栓评分2b/3）。我们使用混合效应逻辑回归，并对治疗地点、年龄和美国国立卫生研究院卒中量表进行了调整。在额外的分析中，我们使用了治疗权重的逆概率，并对阿尔伯塔卒中项目早期CT评分进行了调整。
在纳入STOP-CAD研究的4023例患者中，328例因串联闭塞出现前循环急性缺血性卒中并接受了血管内治疗。中位年龄为51岁（四分位间距，44-58岁），96例患者（29.3%）为女性。150例患者（45.7%）接受了急诊支架置入术。支架置入术与90天功能独立（62.0%对59.7%；调整后的优势比，1.23[95%CI，0.82-1.86]；P=0.315）或有症状性颅内出血（7.3%对7.9%；调整后的优势比，0.95[95%CI，0.41-2.2]；P=0.913）之间无显著关联。急诊颈动脉支架置入术与成功的颅内再通相关（81.8%对76.6%；调整后的优势比，2.62[95%CI，1.52-4.5]；P<0.001）。在额外的分析中，结果没有明显变化。
在因颈段颈动脉夹层继发急性前循环串联闭塞的患者中，急诊支架置入术与更高的颅内再通成功率相关，但并未改善功能结局或增加有症状性颅内出血。尚不清楚是急诊支架置入术导致了颅内再通成功，还是颅内再通成功的患者更有可能接受支架置入术。有必要进行随机试验。
