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Ischemic stroke
Original research
Rescue carotid puncture for ischemic stroke treated by endovascular therapy: a multicentric analysis and systematic review
  1. Julien Allard1,
  2. Sam Ghazanfari2,
  3. Mehdi Mahmoudi3,
  4. Julien Labreuche4,
  5. Simon Escalard1,
  6. François Delvoye1,
  7. Gabriele Ciccio1,
  8. Stanislas Smajda1,
  9. Hocine Redjem1,
  10. Solène Hebert1,
  11. Arturo Consoli5,
  12. Vincent Costalat6,
  13. Jean-Philippe Desilles1,7,8,
  14. Mikael Mazighi1,7,8,
  15. Michel Piotin1,8,
  16. Cyril Dargazanli6,
  17. Bertrand Lapergue2,
  18. Raphaël Blanc1,
  19. Benjamin Maïer1,7,8
  1. 1Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
  2. 2Stroke Center, Hôpital Foch, Suresnes, Île-de-France, France
  3. 3Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
  4. 4ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille University Hospital Center, Lille, Hauts-de-France, France
  5. 5Neuroradiology, Hopital Foch, Suresnes, Île-de-France, France
  6. 6Department of Neuroradiology, University Hospital Centre Montpellier, Montpellier, Occitanie, France
  7. 7Université de Paris, Paris, France
  8. 8Laboratory of Vascular Translational Science, U1148, Paris, France
  1. Correspondence to Dr Raphaël Blanc, Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France; rblanc{at}for.paris

Abstract

Background Endovascular therapy (EVT) for acute ischemic stroke (AIS) can be challenging in older patients with supra-aortic tortuosity. Rescue carotid puncture (RCP) can be an alternative in case of supra-aortic catheterization failure by femoral access, but data regarding RCP are scarce. We sought to investigate the feasibility, effectiveness and safety of RCP for AIS treated by EVT.

Methods Patients treated by EVT with RCP were included from January 2012 to December 2019 in the Endovascular Treatment in Ischemic Stroke (ETIS) multicentric registry. Main outcomes included reperfusion rates (≥TICI2B), 3 month functional outcome (modified Rankin Scale) and 3 month mortality. We also performed an additional systematic review of the literature according to the PRISMA checklist to summarize previous studies on RCP.

Results 25 patients treated by EVT with RCP were included from the ETIS registry. RCP mainly concerned elderly patients (median age 85 years, range 73–92) with supra-aortic tortuosity (n=16 (64%)). Intravenous thrombolysis (IVT) was used for nine patients (36%). Successful reperfusion was achieved in 64%, 87.5% of patients were dependent at 3 months, and 3 month mortality was 45.8%. The systematic review yielded comparable results. In pooled individual data, there was a shift toward better functional outcome in patients with successful reperfusion (median (IQR) 4 (2–6) vs 6 (4–6), p=0.011).

Conclusion RCP mainly concerned elderly patients admitted for AIS with anterior LVO with supra-aortic tortuosity. The procedure seemed feasible, notably for patients treated with IVT, and led to significant reperfusion rates at the end of procedure, but with pronounced unfavorable outcomes at 3 months. RCP should be performed under general anesthesia to avoid life-threatening complications and ensure airways safety. Finally, RCP led to low rates of closure complications, emphasizing that this concern should not withhold RCP, if indicated.

  • stroke
  • thrombectomy
  • cervical

https://doi.org/10.1136/neurintsurg-2020-016725

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    Footnotes

    • Twitter @BenjaminMaer1

    • Contributors Study concept and design: BL, CD, RB, BM. Acquisition of data: JA, SG, MM, CD, RB, BL, BM. Analysis and interpretation of data: JA, SG, MM, JL, SE, FD, GC, SS, HR, SH, AC, VC, JPD, MM, MP, CD, BL, RB, BM. Drafting of the manuscript: JA, JL, MM, MP, BL, RB, BM. Critical revision of the manuscript for important intellectual content: JA, SG, MM, JL, SE, FD, GC, SS, HR, SH, AC, VC, JPD, MM, MP, CD, BL, RB, BM. Statistical analysis: JL. Administrative, technical or material support: BL, RB. Study supervision: BL, RB, BM. All authors read and approved the final 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 None declared.

    • Patient consent for publication Not required.

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

    • Data availability statement Data are available upon reasonable request.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.