Abstract
Purpose: Acute stroke patients presenting with a distal internal carotid artery occlusion and patent carotid terminus, allowing for collateral flow via the circle of Willis, may have a more favorable natural history. Therefore, benefit of endovascular treatment (EVT) is less evident. We performed an exploratory analysis of EVT results compared to conservative treatment in patients with ‘carotid-I’ occlusions. Methods: We report on EVT-treated and non-EVT-treated patients with carotid-I occlusions from the MR CLEAN Registry, MR CLEAN trial, and our comprehensive stroke center. CT-angiography was reviewed on primary collateral patency and choroid plexus enhancement. Perfusion deficits were assessed on CT-perfusion (CTP). Clot migration was assessed by comparing clot location on baseline CTA to its location on periprocedural digital subtraction angiography. Outcomes included 90-day functional independence (mRS 0–2), successful reperfusion and mortality. Results: We included 51 patients. Forty-one patients received EVT, ten patients did not. Intravenous thrombolysis was administered in 32 (78%) EVT-treated patients and 6 (60%) non-EVT-treated patients. CTP, available for 17 patients, showed hypoperfusion on cerebral blood flow maps in 13 (76%) patients. Successful reperfusion after EVT occurred in 23 (56%), and clot migration in 8 patients (20%). Functional independence was achieved in 54% (21/39) of EVT-treated and in 10% (1/10) of non-EVT-treated patients. Mortality was 26% (10/39) and 30% (3/10), respectively. Anterior choroidal artery patency and choroid plexus enhancement were positively associated with functional independence. Conclusion: In our population, data suggest improved outcomes after EVT in carotid-I occlusion patients and provide no arguments to withhold EVT in these patients.
| Original language | English |
|---|---|
| Pages (from-to) | 777-786 |
| Number of pages | 10 |
| Journal | Neuroradiology |
| Volume | 63 |
| Issue number | 5 |
| Early online date | 7 Oct 2020 |
| DOIs | |
| Publication status | Published - May 2021 |
Bibliographical note
Funding Information:The current study received no funding. The MR CLEAN trial was supported by the Dutch Heart Foundation and by unrestricted grants from AngioCare Covidien/ev3, Medac/Lamepro, and Penumbra. The MR CLEAN Registry was funded and carried out by the Erasmus University Medical Centre, the Academic Medical Centre Amsterdam, and the Maastricht University Medical Centre. The Registry was additionally funded by the Applied Scientific Institute for Neuromodulation (Toegepast Wetenschappelijk Instituut voor Neuromodulatie).
Funding Information:
BJE reports grants from Stryker Neurovascular and personal fees from Dekra and from Novartis outside the submitted work. CBLMM reports grants from TWIN during the conduct of the study and grants from CVON/Dutch Heart Foundation and from Stryker outside the submitted work (paid to institution). WHvZ reports personal fees from Cerenovus and from Stryker outside the submitted work. RvdB reports a consultancy agreement with Codman Depuy outside the submitted work. DWJD reports grants from the Dutch Heart Foundation, AngioCare, Medtronic/Covidien/EV3, MEDAC/LAMEPRO, Penumbra, Top Medical/Concentric, and Stryker during conduct of the study; consultation fees from Stryker, Bracco Imaging, and Servier, received by the Erasmus University Medical Centre, outside the submitted work. All other authors did not receive support from any organization for the submitted work, had no financial relationships with any organizations that might have an interest in the submitted work in the previous three years, and had no other relationships or activities that could appear to have influenced the submitted work.
Publisher Copyright:
© 2020, The Author(s).