Endovascular management of extracranial occlusions at the hyperacute phase of stroke with tandem occlusions

Publication date: Available online 11 November 2017
Source:Journal of Neuroradiology
Author(s): Marc-Antoine Labeyrie, Vittorio Civelli, Peggy Reiner, Emmanuel Cognat, Armand Aymard, Annouk Bisdorff, Jean-Pierre Saint-Maurice, Emmanuel Houdart
Background and PurposeThe management of cervical artery occlusions in hyperacute stroke with tandem cervical/intracranial occlusions has not yet become standardized, especially when the circle of Willis is effective.MethodsWe retrospectively analyzed the safety and accuracy of current approaches to manage the cervical occlusion in consecutive patients with tandem occlusions addressed for intracranial mechanical thrombectomy(MT) in our department from January 2012 to May 2017. The different approaches that could be performed in a same patient during the same procedure or hospitalization were analyzed separatly.ResultsWe reported 64 approaches to manage the cervical occlusion in 49 patients with tandem occlusion(14% of MT): medical treatment alone in 16/64(25%), stenting/angioplasty in 16/64(25%), occlusion with coils in 12/64(19%), angioplasty alone in 9/64(14%), stent-retriever in 8/64(12%), and/or thromboaspiration in 3/64(5%). Early ipsilateral embolic recurrence occurred after 9/64(14%) of them. It was strongly associated with the presence of a cervical intraluminal thrombus(P=0.001), and was then lower after occlusion with coils and stent-retriever compared to medical treatment alone and thromboaspiration(P=0.002). Occlusion with coils had a lower rate of radiological intracranial hemorrhage at 48-hour compared to other approaches(P=0.009). The 3-month rates of favorable outcome(P=0.806) and mortality(P=0.878) were similar. One delayed stroke was imputable to an occlusion with coils, for a median(Q1-Q3) follow-up of 10(3-20) months.Conclusionservical occlusion with coils and thrombectomy with stent-retrievers may be relevant to prevent early embolic recurrence in cervical occlusions with intraluminal thrombus. Stent-retrievers should be further assessed as a first-line approach, since delayed stroke may occur following occlusion with coils.



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