Published in:
01-03-2021 | Stroke | Original Article
Mechanical Thrombectomy for Acute Intracranial Carotid Occlusion with Patent Intracranial Arteries
The Italian Registry of Endovascular Treatment in Acute Stroke
Authors:
Fabrizio Sallustio, Valentina Saia, Federico Marrama, Giovanni Pracucci, Roberto Gandini, Giacomo Koch, Alfredo Paolo Mascolo, Federica D’Agostino, Alessandro Rocco, Renato Argiro’, Marco Nezzo, Daniele Morosetti, Andrea Wlderk, Valerio Da Ros, Marina Diomedi, Leonardo Renieri, Patrizia Nencini, Stefano Vallone, Andrea Zini, Guido Bigliardi, Antonio Caragliano, Isabella Francalanza, Sandra Bracco, Rossana Tassi, Mauro Bergui, Andrea Naldi, Andrea Saletti, Alessandro De Vito, Roberto Gasparotti, Mauro Magoni, Luigi Cirillo, Christian Commodaro, Sara Biguzzi, Lucio Castellan, Laura Malfatto, Roberto Menozzi, Ilaria Grisendi, Mirco Cosottini, Giovanni Orlandi, Alessio Comai, Enrica Franchini, Francesco D’Argento, Giovanni Frisullo, Edoardo Puglielli, Alfonsina Casalena, Francesco Causin, Claudio Baracchini, Andrea Boghi, Gigliola Chianale, Raffaele Augelli, Manuel Cappellari, Luigi Chiumarulo, Marco Petruzzellis, Alessandro Sgreccia, Piera Tosi, Nicola Cavasin, Adriana Critelli, Vittorio Semeraro, Giovanni Boero, Francesco Vizzari, Lucia Princiotta Cariddi, Olindo Di Benedetto, Pierfrancesco Pugliese, Marta Iacobucci, Manuela De Michele, Federico Fusaro, Jessica Moller, Luca Allegretti, Tiziana Tassinari, Nunzio Paolo Nuzzi, Simona Marcheselli, Simona Sacco, Marco Pavia, Paolo Invernizzi, Ivan Gallesio, Luigi Ruiz, Sandro Zedda, Rosario Rossi, Pietro Amistà, Monia Russo, Francesco Pintus, Alessandra Sanna, Giuseppe Craparo, Marina Mannino, Domenico Inzitari, Salvatore Mangiafico, Danilo Toni, Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) Collaborators
Published in:
Clinical Neuroradiology
|
Issue 1/2021
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Abstract
Purpose
Intracranial carotid artery occlusion represents an underinvestigated cause of acute ischemic stroke as well as an indication for mechanical thrombectomy. We investigated baseline and procedural characteristics, outcomes and predictors of outcome in patients with acute ischemic stroke secondary to intracranial carotid artery occlusion.
Methods
A retrospective analysis of the Italian Registry of Endovascular Treatment in Acute Stroke was performed. Patients with intracranial carotid artery occlusion (infraclinoid and supraclinoid) with or without cervical artery occlusion but with patent intracranial arteries were included. The 3‑month functional independence, mortality, successful reperfusion and symptomatic intracranial hemorrhage were evaluated.
Results
Intracranial carotid artery occlusion with patent intracranial arteries was diagnosed in 387 out of 4940 (7.8%) patients. The median age was 74 years and median baseline National Institute of Health Stroke Scale (NIHSS) was 18. Functional independence was achieved in 130 (34%) patients, successful reperfusion in 289 (75%) and symptomatic intracranial hemorrhage in 33 (9%), whereas mortality occurred in 111 (29%) patients. In univariate analysis functional independence was associated with lower age, lower NIHSS at presentation, higher rate of successful reperfusion and lower rate of symptomatic intracranial hemorrhage. Multivariable regression analysis found age (odds ratio, OR:1.03; P = 0.006), NIHSS at presentation (OR: 1.07; P < 0.001), diabetes (OR: 2.60; P = 0.002), successful reperfusion (OR:0.20; P < 0.001) and symptomatic intracranial hemorrhage (OR: 4.17; P < 0.001) as the best independent predictors of outcome.
Conclusion
Our study showed a not negligible rate of intracranial carotid artery occlusion with patent intracranial arteries, presenting mostly as severe stroke, with an acceptable rate of 3‑month functional independence. Age, NIHSS at presentation and successful reperfusion were the best independent predictors of outcome.