Safety and Outcome of Carotid Dissection Stenting During the Treatment of Tandem Occlusions
Authors: Marnat Gaultier , Lapergue Bertrand , Sibon Igor , Gariel Florent , Bourcier Romain , Kyheng Maeva , Labreuche Julien , Dargazanli Cyril , Consoli Arturo , Blanc Raphael , Piotin Michel , Mazighi Mikael , Richard Sebastien , Gory Benjamin , Redjem Hocine , Escalard Simon , Desilles Jean-Philippe , Redjem Hocine , Ciccio Gabriele , Smajda Stanislas , Fahed Robert , Obadia Mikael , Sabben Candice , Corabianu Ovide , de Broucker Thomas , Smadja Didier , Alamowitch Sonia , Ille Olivier , Manchon Eric , Garcia Pierre-Yves , Taylor Guillaume , Ben Maacha Malek , Bourdain Frédéric , Decroix Jean-pierre , Wang Adrien , Evrard Serge , Tchikviladze Maya , Coskun Oguzhan , Di Maria Federico , Rodesh Georges , Leguen Morgan , Tisserand Marie , Pico Fernando , Rakotoharinandrasana Haja , Tassan Philippe , Poll Roxanna , Nighoghossian Norbert , Riva Roberto , Eker Omer , turjman Francis , Derex Laurent , Cho Tae-Hee , Mechtouff Laura , Claire Lukaszewicz Anne , Philippeau Frédéric , Cakmak Serkan , Blanc-Lasserre Karine , Vallet Anne-Evelyne , Barreau Xavier , Berge Jérôme , Menegon Patrice , Lucas Ludovic , Olindo Stéphane , Renou Pauline , Sagnier Sharmila , Poli Mathilde , Debruxelles Sabrina , Rouanet François , Tourdias Thomas , Liegey Jean-Sebastien , Detraz Lili , Daumas-Duport Benjamin , Alexandre Pierre-Louis , Roy Monica , Lenoble Cédric , L’allinec Vincent , Girot Jean-Baptiste , Desal Hubert , Bracard Serge , Anxionnat René , Braun Marc , Derelle Anne-Laure , Tonnelet Romain , Liao Liang , Zhu François , Schmitt Emmanuelle , Planel Sophie , Humbertjean Lisa , Mione Gioia , Lacour Jean-Christophe , Bonnerot Mathieu , Riou-Comte Nolwenn , Costalat Vincent , Gascou Grégory , Lefèvre Pierre-Henri , Derraz Imad , Riquelme Carlos , Arquizan Caroline , Gaillard Nicolas , Mourand Isabelle , Corti Lucas , Cagnazzo Federico ,   Thrombectomy in Tandem Lesion Investigators, Anadani Mohammad , Spiotta Alejandro , Alawieh Ali , Turjman Francis , Haussen Diogo , Nogueira Raul , Papanagiotou Panagiotis , Siddiqui Adnan H. , Dorn Franziska , Cognard Christophe , Ribo Marc , Psychogios Marios , Labeyrie Marc Antoine , Biondi Alessandra , Andrew Grossberg Jonathan , Guenego Adrien , Darcourt Julien , Vukasinovic Isabelle , Pomero Elisa , Davies Jason , Renieri Leonardo , Hecker Corentin , Muchada Muchada Maria , Houdart Emmanuel , Turner Raymond , Turk Aquilla , Chaudry Imran , Lockau Johanna , Kastrup Andreas , Behme Daniel , Shallwani Hussain , Christopher Maurer , Mione Gioia 
Published: November 2020

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.