Safety and Outcome of Carotid Dissection Stenting During the Treatment of Tandem Occlusions: A Pooled Analysis of TITAN and ETIS

Gaultier Marnat (1) , Bertrand Lapergue (2, 3) , Igor Sibon (4) , Florent Gariel (1) , Romain Bourcier (5, 6) , Maeva Kyheng (7, 8, 9) , Julien Labreuche (7, 8, 9) , Cyril Dargazanli (10) , Arturo Consoli (2, 11, 3) , Raphael Blanc (6) , Michel Piotin (6) , Mikael Mazighi (6) , Sebastien Richard (12, 13) , Benjamin Gory (14, 11) , Hocine Redjem , Simon Escalard , Jean-Philippe Desilles , Gabriele Ciccio , Stanislas Smajda , Robert Fahed , Mikael Obadia , Candice Sabben , Ovide Corabianu , Thomas de Broucker , Didier Smadja , Sonia Alamowitch , Olivier Ille , Eric Manchon , Pierre-Yves Garcia , Guillaume Taylor , Malek Ben Maacha , Frédéric Bourdain , Jean-Pierre Decroix , Adrien Wang , Serge Evrard , Maya Tchikviladze , Oguzhan Coskun , Federico Di Maria , Georges Rodesh , Morgan Leguen , Marie Tisserand , Fernando Pico , Haja Rakotoharinandrasana , Philippe Tassan , Roxanna Poll , Norbert Nighoghossian , Roberto Riva , Omer Eker , Francis Turjman , Laurent Derex , Tae-Hee Cho , Laura Mechtouff , Anne Claire Lukaszewicz , Frédéric Philippeau , Serkan Cakmak , Karine Blanc-Lasserre , Anne-Evelyne Vallet , Xavier Barreau , Jérôme Berge , Patrice Menegon , Ludovic Lucas , Stéphane Olindo , Pauline Renou , Sharmila Sagnier , Mathilde Poli , Sabrina Debruxelles , François Rouanet , Thomas Tourdias , Jean-Sebastien Liegey , Lili Detraz , Benjamin Daumas-Duport , Pierre-Louis Alexandre , Monica Roy , Cédric Lenoble , Vincent L’allinec , Jean-Baptiste Girot , Hubert Desal , Serge Bracard (14, 11) , René Anxionnat (14, 11) , Marc Braun (11) , Anne-Laure Derelle , Romain Tonnelet , Liang Liao , François Zhu (11) , Emmanuelle Schmitt , Sophie Planel , Lisa Humbertjean , Gioia Mione , Jean-Christophe Lacour , Mathieu Bonnerot , Nolwenn Riou-Comte , Vincent Costalat (15, 16) , Grégory Gascou , Pierre-Henri Lefèvre , Imad Derraz , Carlos Riquelme , Caroline Arquizan , Nicolas Gaillard , Isabelle Mourand , Lucas Corti , Federico Cagnazzo , Mohammad Anadani , Alejandro Spiotta , Ali Alawieh , Diogo Haussen , Raul Nogueira , Panagiotis Papanagiotou , Adnan Siddiqui , Franziska Dorn , Christophe Cognard , Marc Ribo , Marios Psychogios , Marc Antoine Labeyrie , Alessandra Biondi , Jonathan Andrew Grossberg , Adrien Guenego , Julien Darcourt , Isabelle Vukasinovic , Elisa Pomero , Jason Davies , Leonardo Renieri , Corentin Hecker , Maria Muchada Muchada , Emmanuel Houdart , Raymond Turner , Aquilla Turk , Imran Chaudry , Johanna Lockau , Andreas Kastrup , Daniel Behme , Hussain Shallwani , Maurer Christopher

1 DNR - Bordeaux - Département de Neuro-Radiologie [Bordeaux]
2 Hôpital Foch [Suresnes]
3 UVSQ Santé - Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil
4 Service de neurologie [Bordeaux]
5 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
6 Fondation Ophtalmologique Adolphe de Rothschild [Paris]
7 EA 2694 - Santé Publique : épidémiologie et qualité des soins
8 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
9 METRICS - Evaluation des technologies de santé et des pratiques médicales - ULR 2694
10 Département de Neuroradiologie[Montpellier]
11 IADI - Imagerie Adaptative Diagnostique et Interventionnelle
12 Service de neurologie [CHRU Nancy]
13 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
14 Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy]
15 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
16 UM - Université de Montpellier

Background and Purpose: The efficacy of endovascular therapy in patients with acute ischemic stroke due to tandem occlusion is comparable to that for isolated intracranial occlusion in the anterior circulation. However, the optimal management of acute cervical internal carotid artery lesions is unknown, especially in the setting of carotid dissection, but emergency carotid artery stenting (CAS) is frequently considered. We investigated the safety and efficacy of emergency CAS for carotid dissection in patients with acute stroke with tandem occlusion in current clinical practice. Methods: We retrospectively analyzed a prospectively maintained database composed of 2 merged multicenter international observational real-world registries (Endovascular Treatment in Ischemic Stroke and Thrombectomy in Tandem Lesion). Data from endovascular therapy performed in the treatment of tandem occlusions related to acute cervical carotid dissection between January 2012 and January 2019 at 24 comprehensive stroke centers were analyzed. Results: The study assessed 136 patients with tandem occlusion due to dissection, including 65 (47.8%) treated with emergency CAS and 71 (52.2%) without. The overall rates of favorable outcome (90-day modified Rankin Scale score, 0–2) and successful reperfusion (modified Thrombolysis in Cerebral Infarction, 2b–3) were 58.0% (n=76 [95% CI, 49.6%–66.5%]) and 77.9% (n=106 [95% CI, 71.0%–85.0%]), respectively. In subgroup analyses, the rate of successful reperfusion (89.2% versus 67.6%; adjusted odds ratio, 2.24 [95% CI, 1.33–3.77]) was higher after CAS, whereas the 90-day favorable outcome (54.3% versus 61.4%; adjusted odds ratio, 0.84 [95% CI, 0.58–1.22]), symptomatic intracerebral hemorrhage (sICH; 10.8% versus 5.6%; adjusted odds ratio, 1.59 [95% CI, 0.79–3.17]), and 90-day mortality (8.0% versus 5.8%; adjusted odds ratio, 1.00 [95% CI, 0.48–2.09]) did not differ. In sensitivity analyses of patients with successful intracranial reperfusion, CAS was not associated with an improved clinical outcome. Conclusions: Emergency stenting of the dissected cervical carotid artery during endovascular therapy for tandem occlusions seems safe, whatever the quality of the intracranial reperfusion.

Mots clés: carotid dissection; cerebral hemorrhage; cerebral infarction; dissection; internal carotid artery; reperfusion

Domaines: Cardiologie et système cardiovasculaire

Gaultier Marnat, Bertrand Lapergue, Igor Sibon, Florent Gariel, Romain Bourcier, et al.. Safety and Outcome of Carotid Dissection Stenting During the Treatment of Tandem Occlusions: A Pooled Analysis of TITAN and ETIS. Stroke, 2020, 51 (12), pp.3713-3718. ⟨10.1161/STROKEAHA.120.030038⟩. ⟨hal-03230987⟩