Efficacy of emergent internal carotid artery stenting after intracranial thrombectomy for acute internal carotid artery stenosis related tandem lesions

Abstract

Objective To investigate the efficacy and safety of emergent carotid artery stenting (CAS) after intracranial artery mechanical thrombectomy for acute internal carotid artery (ICA) stenosis related tandem lesions. Methods A total of 79 patients with acute ICA stenosis related tandem lesions admitted to the Advanced Stroke Center of Zhangzhou Hospital affiliated to Fujian Medical University from January 2015 to December 2019 were selected. All patients underwent urgent endovascular therapy with "half" anterograde approach with or without usage of embolic prevention device (EPD) technology, and divided into CAS group (n=47) and non⁃CAS group (n=32) according to whether CAS was performed in emergency. Compared and analysed the 2 groups of surgical related indexes [including the preoperative Alberta Stroke Program Early CT Score (ASPECTS), the occlusion site of tandem lesions, the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology Collateral Flow Grading System (ASITN/SIR ACG), puncture⁃to⁃reperfusion time, leakage on C⁃arm CT, incidence of distal embolism], and the clinical prognostic indicators [including the incidence of symptomatic intracranial hemorrhage (sICH), culprit artery reocclusion rate, postoperative 90⁃d favorable outcome rate and mortality]. Univariate and multivariate forward Logistic regression were used to analysis the influencing factors of postoperative 90⁃d poor prognosis in acute ICA stenosis related tanchem lesions. Results All 79 patients had immediate postoperative mTICI grading≥2b, the vascular recanalization rate was 100%. There was no statistically significant differences in the preoperative ASPECTS (t=⁃0.170, P=0.865), the occlusion site of tandem lesions (Z=5.907, P=0.091), the ASITN/SIR ACG (t=⁃0.900，P=0.368）, puncture⁃to⁃reperfusion time (t=0.182, P=0.856), leakage on C⁃arm CT (Z=⁃0.171, P=0.864), incidence of distal embolism (χ2=0.872, P=0.350), the incidence of sICH (χ2=1.670, P=0.434), the culprit artery re⁃occlusion rate (χ2=0.000, P=1.000), postoperative 90⁃d favorable outcome rate (χ2=2.149, P=0.143) and the mortality (χ2=0.150, P=0.699) between CAS group and non⁃CAS group. Logistic regression analysis showed that increasing age (OR=1.078, 95%CI: 1.011-1.148; P=0.021), leakage on C⁃arm CT (OR=5.163, 95%CI: 1.633-16.326; P=0.005) were risk factors for postoperaive 90⁃d poor outcomes of the patients with acute carotid atherosclerotic stenosis related tandem lesions. Conclusions For patients with acute ICA stenosis related tandem lesions used "half" anterograde approach with or without usage of EPD technology, the decision of emergent CAS after mechanical thrombectomy was made according to the stenosis degree of ICA and leakage on C⁃arm CT. This strategy is safe and feasible, and has the potential of clinical promotion.

Keywords

• carotid stenosis
• thrombectomy
• stents
• risk factors
• logistic models