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Updated: Jul 4, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Impact of Day 1 carotid patency on outcome in dissection-related tandem occlusions treated with mechanical
Guillaume Perrin1, Elisabeth Molinier1, Benjamin Gory2
1Neurology department, Tours University Hospital, Tours, France.
Insights
Cervical internal carotid artery (ICA) patency after mechanical thrombectomy for stroke did not impact 3-month outcomes. Stenting the cervical ICA may not be routinely necessary for tandem occlusions caused by dissection.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Surgery
Background:
- Mechanical thrombectomy (MT) offers similar benefits for stroke patients with tandem occlusions and isolated intracranial occlusions.
- Management of cervical internal carotid artery (ICA) occlusion during MT, especially with carotid dissection, remains debated.
- Investigating the impact of cervical ICA patency on functional outcomes is crucial.
Purpose of the Study:
- To evaluate the clinical impact of cervical ICA patency at day 1 post-MT on 3-month functional outcomes.
- To determine if endovascular recanalization of the cervical ICA is essential in tandem occlusions secondary to dissection.
Main Methods:
- Prospective data from 30 French centers performing MT (Jan 2015-Jan 2022) were analyzed.
- Included patients had tandem occlusions related to cervical ICA dissection treated with MT.
- Primary endpoint: 3-month functional outcome; Secondary endpoints: ICH, excellent outcome, mortality, early neurological improvement.
Main Results:
- 137 patients were included; 89 (65%) had ICA patency at day 1.
- No significant difference in favorable outcome between patent and occluded ICA groups (68.7% vs 59.1%).
- Excellent outcome, mortality, and intracranial hemorrhage (ICH) rates were comparable between groups.
Conclusions:
- Cervical ICA patency at day 1 did not influence 3-month functional outcomes in dissection-related tandem occlusions.
- Systematic endovascular recanalization of the cervical ICA, including stenting, may not be required.
Background:
The clinical benefit of mechanical thrombectomy(MT) for stroke patients with tandem occlusion is similar to that of isolated intracranial occlusions. However, the management of cervical internal carotid artery(ICA) occlusion during the MT, particularly in the setting of carotid dissection, remains controversial. We aimed to investigate the clinical impact of cervical ICA patency at day 1 on 3-month functional outcome.
Methods:
We collected data from the Endovascular Treatment in Ischemic Stroke, a prospective national registry in 30 French centers performing MT between January 2015 and January 2022. Inclusion criteria were consecutive tandem occlusions related to cervical ICA dissection treated with MT. Tandem occlusions of other etiology, isolated cervical ICA occlusions without intracranial thrombus and patients without day-1 ICA imaging were excluded. Primary endpoint was the 3-month functional outcome. Secondary endpoints included intracranial hemorrhage(ICH), excellent outcome, mortality and early neurological improvement. A sensitivity analysis was performed in patients with intracranial favorable recanalization after MT.
Results:
During the study period, 137 patients were included of which 89(65%) presented ICA patency at day 1. The odds of favorable outcome did not significantly differ between patients with patent and occluded ICA at day 1(68.7 vs 59.1%;aOR=1.30;95%CI 0.56-3.00,p=0.54). Excellent outcome, early neurological improvement, mortality and ICH were also comparable between groups. Sensitivity analysis showed similar results.
Conclusion:
ICA patency at day 1 in patients with tandem occlusions related to dissection did not seem to influence functional outcome. Endovascular recanalization of the cervical ICA including stenting might not be systematically required in this setting.
