Background The benefit of acute carotid stenting compared with no acute stenting on clinical outcomes among patients with tandem lesions (TL) undergoing endovascular thrombectomy (EVT) remains unknown.
Methods We conducted a a systematic review and meta-analysis of studies comparing acute carotid stenting versus no stenting among TL patients undergoing EVT with regards to 90 day modified Rankin Scale (mRS) score, symptomatic intracerebral hemorrhage (sICH), and mortality. Four reviewers screened citations for eligibility and two assessed retained studies for risk of bias and data extraction. A random effects model was used for the synthesis of aggregated data.
Results 21 studies (n=1635 patients) were identified for the systematic review; 19 were cohort studies, 1 was a post-hoc analysis of an EVT trial, and 1 was a pilot randomized controlled trial. 16 studies were included in the meta-analysis. Acute stenting was associated with a favorable 90 day mRS score: OR 1.43 (95% CI 1.07, 1.91). No significant heterogeneity between studies was found for this outcome (I2=17.0%; χ2=18.07, p=0.26). There were no statistically significant differences for 3 month mortality (OR 0.80 (95% CI 0.50, 1.28)) or sICH (OR 1.41 (95% CI 0.91, 2.19)).
Conclusions This meta-analysis suggests that among TL patients undergoing EVT, acute carotid stenting is associated with a greater likelihood of favorable outcome at 90 days compared with no stenting.
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Correction notice Since the online publication of this article, Figure 3 has been replaced as it was incorrectly linked to this paper and affiliation 5 was updated to remove 'Centre de documentation'.
Contributors GD: data acquisition, data analysis, and interpretation, and writing and revising the manuscript. BYC: data acquisition, data analysis, and interpretation. GJ: design and conceptualization of the study, data acquisition, data analysis, and interpretation, and revising the manuscript. MK: statistical analysis and data interpretation, and writing and revising the manuscript. ML: data acquisition, data analysis, and interpretation. BR: statistical analysis and interpretation. CS: design and conceptualization of the study, data acquisition, data analysis, and interpretation, and revising the manuscript. DZ: study design and data acquisition. AYP: design and conceptualization of the study, data acquisition, data analysis, and interpretation, and revising the manuscript.
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 AYP is the principal investigator for a forthcoming trial of patients with tandem lesions, Endovascular Acute Stroke Intervention–Tandem OClusion study (EASI-TOC), for which he has received a networking grant from the Canadian Stroke Trials for Optimized Results (CaSTOR) initiative.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable requests by qualified investigators to the corresponding author.