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3. Comparison of aspiration versus combined technique as first-line approach in terminal internal carotid artery occlusion: a multicenter experience

Author

Andrea Zini, Maria Ruggiero, Vittorio Semeraro, Giulia Frauenfelder, Agostino Tessitore, Alessandro Pesce, Sandra Bracco, Daniele Giuseppe Romano, Nicola Burdi, Sergio Vinci, Luigi Simonetti, Mariano Velo, Maria Porzia Ganimede, Luigi Cirillo, Renato Saponiero, Beatrice Modello, Christian Commodaro, Samuele Cioni, Matteo Zanoni, Aldo Paolucci, Francesco Diana, Diana F., Vinci S.L., Ruggiero M., Semeraro V., Bracco S., Frauenfelder G., Paolucci A., Cirillo L., Pesce A., Tessitore A., Commodaro C., Ganimede M.P., Zanoni M., Saponiero R., Zini A., Velo M., Modello B., Burdi N., Cioni S., Simonetti L., and Romano D.G.

Subjects
Carotid Artery Diseases, thrombolysis, medicine.medical_specialty, medicine.medical_treatment, Arterial Occlusive Diseases, Brain Ischemia, Modified Rankin Scale, Occlusion, Post-hoc analysis, medicine, Humans, Stroke, intervention, Ischemic Stroke, Retrospective Studies, Thrombectomy, stent, stroke, thrombectomy, Cerebral infarction, business.industry, Endovascular Procedures, Stent, General Medicine, Thrombolysis, medicine.disease, Treatment Outcome, Stents, Surgery, Neurology (clinical), Radiology, business, Carotid Artery, Internal, Cohort study
Abstract

BackgroundThere is no consensus on the most effective endovascular technique to use in patients with acute ischemic stroke due to terminal internal carotid artery (ICA) occlusion. The aim of this study was to compare safety and efficacy of the aspiration technique (AT) and combined technique (CT) as first-line approach in terminal ICA occlusions.MethodsWe performed a retrospective analysis of prospectively collected databases from seven Italian stroke centers. Patients were divided into two subgroups according to the first-line approach: AT group or CT group. We followed the STROBE guidelines for cohort studies. We used Chi-square test, one-way and multivariate ANOVA analysis, together with contrast analysis and post hoc tests, logistic regression and Pearson’s bivariate correlation for the statistical analyses.ResultsBetween January 2018 and August 2020, 353 patients were treated for a terminal ICA occlusion, with either AT or CT. CT was associated with a higher Thrombolysis in Cerebral Infarction (TICI) 2B-3 after the first pass (51.0% vs 26.9%) and at the end of the procedure (84% vs 73.3%) and with an improved clinical outcome at discharge (modified Rankin Scale (mRs) 0–2 of 47.8% vs 34.0%) and at 3 months’ follow-up (mRs 0–2 of 56.5% vs 38.9%) compared with AT.ConclusionThrombectomy of terminal ICA occlusions obtained using CT as first-line approach demonstrated better technical and functional outcomes in comparison with AT.

Published
2021

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