Rodgers, M.P. (MIchael) (2019) Acute ischemic stroke with tandem lesions: immediate carotid stenting during mechanical thrombectomy not associated with clinical outcome – a multicenter observational study. thesis, Medicine.
Full text available on request.Abstract
Background: Although tandem lesions form a significant proportion of all strokes treated by intra-arterial therapy (IAT), the optimal treatment strategy for the extracranial lesion remains unknown. Previous studies have shown conflicting results on whether acute stenting of the extracranial lesion is safe or leads to better clinical outcome. Additionally, it is unknown whether the extracranial or intracranial first approach leads to better outcomes. Aim: To determine whether immediate stenting of the proximal carotid artery stenosis/occlusion during IAT is safe and effective, and secondly to examine whether any association could be found between an extracranial or intracranial first approach and clinical outcomes. Methods: Through a multicenter observational study using data prospectively collected from 2014 to 2016 at 18 hospitals in the Netherlands performing IAT. A total of 1526 patients were evaluated. Univariate and multivariate regression analyses were performed to assess associations between procedure technique and outcomes. The primary endpoint was functional independency defined as a score of 0-2 on the modified Rankin Scale (mRS) at 90 days. Secondary endpoints were successful reperfusion (eTICI 2b or higher), incidence of any serious adverse events, and incidence of symptomatic intracranial hemorrhage. Results: Of the 211 patients with tandem lesions treated with IAT, 94 patients (45%) underwent acute stenting, of whom 70 (74%) were stented before the intracranial thrombectomy. No association was found between acute stent placement and good functional outcomes, successful reperfusion, incidence of any serious adverse events, or incidence of symptomatic intracranial hemorrhage, nor was any association found between an intracranial or extracranial first approach and clinical outcomes. These results persisted after adjusting for covariates. Conclusion: No evidence was found either in support of or against acute stenting of the extracranial lesion during IAT, as no difference was found in clinical outcomes, procedural success rate, or safety. Also, no evidence was found favoring either an extracranial or an intracranial first approach.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Uyttenbogaert, Dr. M. |
| Faculty: | Medical Sciences |
| Keywords: | Neurology, Ischaemic Stroke, treatment |
| Date Deposited: | 13 Jul 2020 07:05 |
| Last Modified: | 13 Jul 2020 07:12 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2743 |
Actions (login required)
 |
View Item |