Impact of Day 1 carotid patency on outcome in dissection-related tandem occlusions treated with mechanical...

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.