Common carotid artery puncture in anterior circulation thrombectomy in patients with unfavorable vascular anatomy: A case-control study
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Published on: August 11, 2015
Zhengzhou Yuan1,2, Jinglun Li2, Muke Zhou1
1West China Hospital of Sichuan University, Department of Neurology, ChenDu.
Insights
Transcarotid access for mechanical thrombectomy in patients with unfavorable vascular anatomy showed a faster reperfusion time and fewer poor outcomes compared to transfemoral access. This suggests transcarotid access may be a viable alternative for selected patients.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Surgery
Background:
- Mechanical thrombectomy (MT) is a crucial treatment for acute ischemic stroke due to large vessel occlusion (LVO).
- Patients with unfavorable vascular anatomy present challenges for standard transfemoral MT.
- Transcarotid access is an alternative approach for MT in complex cases.
Purpose of the Study:
- To compare clinical outcomes of MT using transcarotid versus transfemoral access in patients with unfavorable vascular anatomy and anterior circulation LVO.
- To evaluate the safety and efficacy of transcarotid access in this specific patient population.
Main Methods:
- Retrospective review of a hospital database for patients undergoing MT for anterior circulation LVO between August 2015 and November 2018.
- Comparison of patient characteristics, procedural details, and clinical outcomes between transcarotid and transfemoral access cohorts.
- Analysis included access-to-reperfusion time, functional outcome (modified Rankin Scale), revascularization rates, symptomatic intracranial hemorrhage, and mortality.
Main Results:
- A total of 52 patients were analyzed, with 16 undergoing transcarotid access.
- The transcarotid cohort demonstrated a significantly shorter mean access-to-reperfusion time (44 minutes vs. 84 minutes).
- Poor clinical outcome (modified Rankin Scale >2) at 90 days was significantly lower in the transcarotid group (37.5% vs. 63.9%).
- Successful revascularization rates, symptomatic intracranial hemorrhage, and mortality were similar between the two groups.
Conclusions:
- Transcarotid access for MT in anterior circulation LVO with unfavorable vascular anatomy is a considerable option.
- This approach may offer superior outcomes, particularly in terms of reperfusion time and functional recovery, in well-selected patients.
- Further prospective studies are warranted to confirm these findings.
Abstract:
The objective of this study was to compare clinical outcomes in patients who with unfavorable vascular anatomy underwent mechanical thrombectomy (MT) by common carotid artery access versus transfemoral approach.A retrospective review was performed in our hospital database to identify patients with challenging vascular anatomy who underwent MT for anterior circulation large vessel occlusion (LVO) between August 2015 and November 2018. Transcarotid and transfemoral cohorts were compared. Patient characteristics, procedural techniques, clinical outcomes were recorded.A total of 52 patients were included, 16 (31%) underwent MT via transcarotid access. There were no significant differences in patient characteristics, intravenously recombinant tissue plasminogen activator therapy, clot location, or carotid tortuosity and presence of aortic arch type. There were significant differences in clinical outcomes between the 2 cohorts, including mean access-to-reperfusion time (84 vs 44 minutes; P = .000), poor clinical outcome (modified Rankin scale >2) at 90 days follow-up (37.5% vs 63.9%; P = .034). But there were no significant differences in successful revascularization rates (thrombolysis in cerebral infarction score ≥2b 87.5% vs 80.6%; P = .541), post-thrombectomy symptomatic intracranial hemorrhage (12.5% vs 13.9%; P = .892), and mortality (12.5% vs 22.2%; P = .412) were similar between transcarotid and transfemoral cohorts.Our results demonstrate that transcarotid access for MT of anterior circulation LVO in patients with unfavorable vascular anatomy may be considerable. Transcarotid access may be better than transfemoral access in well-selected unfavorable vascular anatomy patients undergoing MT.
