Relevance of cervical internal carotid artery patency after thrombectomy in tandem occlusion. Are we missing an...

Area of Science:

• Neuroendovascular surgery
• Cerebrovascular disease management
• Interventional neurology

Background:

• Tandem occlusions (TOs) involving the cervical internal carotid artery (c-ICA) present treatment challenges.
• Emergent carotid artery stenting (eCAS) and angioplasty are key interventions for c-ICA occlusion.
• The impact of c-ICA reocclusion on stroke recurrence and functional outcomes requires further investigation.

Purpose of the Study:

• To evaluate the effect of c-ICA reocclusion on recurrent ischemic stroke (IS) and stroke-related death.
• To assess the association between c-ICA reocclusion and 90-day functional independence.
• To identify predictors of c-ICA reocclusion and future revascularization.

Main Methods:

• Retrospective analysis of 163 patients with TOs undergoing endovascular thrombectomy (EVT) from April 2016 to October 2024.
• Primary outcome: 90-day composite of recurrent IS and stroke-related death.
• Secondary outcomes: 90-day functional independence (mRS 0-2) and mortality; binary logistic regression used to analyze associations and predictors.

Main Results:

• Cervical internal carotid artery reocclusion occurred in 22% of patients.
• Reocclusion significantly increased the odds of recurrent IS or stroke-related death (aOR 2.90) and was linked to poorer functional independence (aOR 0.18).
• Angioplasty and residual stenosis were predictors of reocclusion or future revascularization in patients not undergoing eCAS.

Conclusions:

• Maintaining c-ICA patency post-EVT is critical for reducing recurrent IS, stroke-related death, and improving functional outcomes.
• Residual c-ICA stenosis and angioplasty serve as important predictors for managing c-ICA patency during EVT.
• These findings underscore the importance of strategies to prevent c-ICA reocclusion after EVT for TOs.