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

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Ischemic stroke
Original research
Comparison of aspiration versus combined technique as first-line approach in terminal internal carotid artery occlusion: a multicenter experience
  1. Francesco Diana1,
  2. Sergio Lucio Vinci2,
  3. Maria Ruggiero3,
  4. Vittorio Semeraro4,
  5. Sandra Bracco5,
  6. Giulia Frauenfelder1,
  7. Aldo Paolucci6,
  8. Luigi Cirillo7,8,
  9. Alessandro Pesce9,
  10. Agostino Tessitore2,
  11. Christian Commodaro3,
  12. Maria Porzia Ganimede4,
  13. Matteo Zanoni5,
  14. Renato Saponiero1,
  15. Andrea Zini10,
  16. Mariano Velo2,
  17. Beatrice Modello3,
  18. Nicola Burdi4,
  19. Samuele Cioni5,
  20. Luigi Simonetti7,
  21. Daniele Giuseppe Romano1
  1. 1 Department of Neuroradiology, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy
  2. 2 Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
  3. 3 Neuroradiology Unit, AUSL Romagna, Maurizio Bufalini Hospital, Cesena, Italy
  4. 4 Department of Diagnostic and Interventional Imaging, Santissima Annunziata Hospital, Taranto, Italy
  5. 5 Unit of Interventional Neuroradiology, Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena, Policlinico "Santa Maria Alle Scotte", Siena, Italy
  6. 6 Unit of Neuroradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milano, Italy
  7. 7 Neuroradiology Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy
  8. 8 DIBINEM, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
  9. 9 Department of Neurosurgery, Ospedale Santa Maria Goretti, Latina, Italy
  10. 10 Department of Neurology and Stroke Center, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy
  1. Correspondence to Dr Francesco Diana, Department of Neuroradiology, A.O.U. San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy; francesco.diana.md{at}gmail.com

Abstract

Background There 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.

Methods We 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.

Results Between 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.

Conclusion Thrombectomy of terminal ICA occlusions obtained using CT as first-line approach demonstrated better technical and functional outcomes in comparison with AT.

  • stroke
  • thrombectomy
  • intervention
  • stent
  • thrombolysis

Data availability statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

https://doi.org/10.1136/neurintsurg-2021-017585

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    Data availability statement

    The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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    Footnotes

    • Twitter @fdianamd

    • Contributors Study conception and design: FD and DGR. Data acquisition: FD, GF, AT, MV, CC, BM, VS, MG, APa, MZ, SC and LC. Data analysis and interpretation: FD and APe. Manuscript drafting: FD and APe. Critical revision: SLV, MR, NB, SB, APa, LC, RS, AZ and LS. Final approval: all authors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.