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Ischemic stroke
Original research
Clinical and safety outcomes of acute stenting plus thrombectomy for carotid tandem lesions with large ischemic core
  1. Yakub Deliktas1,
  2. Imad Derraz2,
  3. Stephanos Finitsis3,
  4. Jildaz Caroff4,
  5. Romain Bourcier5,
  6. Sébastien Soize6,
  7. Solène Moulin7,
  8. Sébastien Richard8,
  9. Gaultier Marnat9,
  10. Matúš Hoferica10,
  11. Christophe Cognard10,
  12. Jean-Philippe Desilles11,
  13. Mohammad Anadani12,
  14. Jean-Marc Olivot13,
  15. Barbara Casolla14,
  16. Arturo Consoli15,
  17. Bertrand Lapergue16,
  18. Benjamin Gory1,17
  19. On behalf of the ETIS Registry Investigators
      1. 1Diagnostic and Therapeutic Neuroradiology, CHRU Nancy, Nancy, France
      2. 2Neuroradiology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
      3. 3Neuroradiology, Aristotle University of Thessaloniki, Ahepa Hospital, Thessaloniki, Greece
      4. 4Interventional Neuroradiology - NEURI Brain Vascular Center, Hôpital Bicêtre, Le Kremlin Bicêtre, France
      5. 5Neuroradiology, CHU Nantes, Nantes, France
      6. 6Neuroradiology, CHU Reims, Reims, France
      7. 7Neurology, CHU Reims, Reims, France
      8. 8Neurology Stroke Unit, CHRU Nancy, Nancy, France
      9. 9Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
      10. 10Diagnostic and Therapeutic Neuroradiology, Hôpital Purpan, Toulouse, France
      11. 11Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
      12. 12Department of Neurosciences, Intent Medical Group, NorthShore University HealthSystem, Arlington Heights, Illinois, USA
      13. 13Neurology, Stroke Unit, Hôpital Purpan, Toulouse, France
      14. 14Neurology, Stroke Unit, CHU Nice, Nice, France
      15. 15Diagnostic and Interventional Neuroradiology, Hôpital Foch, Suresnes, France
      16. 16Neurology, Stroke Unit, Hôpital Foch, Suresnes, France
      17. 17Université de Lorraine, INSERM U1254, IADI, Nancy, France
      1. Correspondence to Professor Benjamin Gory, Department of Diagnostic and Interventional Neuroradiology, CHRU de Nancy, Nancy, Grand Est, France; b.gory{at}chru-nancy.fr

      Abstract

      Background We evaluated the clinical and safety outcomes of emergent carotid artery stenting (eCAS) plus endovascular thrombectomy (EVT) among patients with anterior tandem lesion (TL) and large ischemic core (LIC).

      Methods This retrospective study included consecutive stroke patients enrolled in the Endovascular Treatment in Ischemic Stroke Registry in France between January 2015 and June 2023. We compared the outcomes of carotid stenting vs no stenting in tandem lesion with pre-treatment LIC (Alberta Stroke Program Early CT Score (ASPECTS) 3–5) and stenting in tandem lesion vs thrombectomy alone for isolated intracranial occlusions with pre-treatment LIC. Primary outcome was a score of 0 to 3 on the modified Rankin scale (mRS) at 90 days. Multivariable mixed-effects logistic regression was performed.

      Results Among 218 tandem patients with LIC, 55 were treated with eCAS plus EVT. The eCAS group had higher odds of 90-day mRS 0–3 (adjusted Odds Ratio (aOR) 2.40, 95% confidence interval (CI) 1.10 to 5.21; p=0.027). There were no differences in the risk of any intracerebral hemorrhage (OR 1.41, 95% CI 0.69 to 2.86; p=0.346), parenchymal hematoma (aOR 1.216, 95% CI 0.49 to 3.02; p=0.675), symptomatic intracerebral hemorrhage (aOR 1.45, 95% CI 0.60 to 3.48; p=0.409), or 90-day mortality (aOR 0.74, 95% CI 0.33 to 1.68; p=0.472). eCAS was associated with a higher rate of carotid patency at day 1 (aOR 3.54, 95% CI 1.14 to 11.01; p=0.028). Safety outcomes were similar between EVT+eCAS group in TL-LIC and EVT alone group in isolated intracranial occlusions with LIC.

      Conclusion eCAS appears to be a safe and effective strategy in patients with TL and LIC volume.

      • Stroke
      • Thrombectomy
      • Stent
      • Complication
      • Cervical

      Data availability statement

      Data are available upon reasonable request.

      https://doi.org/10.1136/jnis-2024-021517

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        Data availability statement

        Data are available upon reasonable request.

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        • Collaborators ETIS investigators: 001-Foch: Bertrand LAPERGUE, Adrien WANG, Arturo CONSOLI, Oguzhan COSKUN, Federico DI MARIA, Silvia PIZZUTO, Alessandro SGRECCIA, Charline BENOIT, Lucas GORZA, David WEISENBURGER-LILE, WaliydeJABEUR, TCHIKVILADZE Maia, Serge EVRARD, Georges RODESCH. 002-FOR Raphaël BLANC, Michel OBADIA, Jean-Philippe DESILLES, Michel PIOTIN, Pierre SENERS, Stanislas SMAJDA, Simon ESCALARD, Benjamin MAIER, Candice SABBEN, Hocine REDJEM, Mikael MAZHIGI, Grace ADWANE, François DELVOYE, Amira AL RAAISI, William BOISSEAU,ALTAYEB Adnan, ROBICHON Erwan. 003-Lyon Omer EKER, Tae-Hee CHO, Laurent DEREX, Julia FONTAINE, Laura MECHTOUFF, Norbert NIGHOGHOSSIAN, Elodie ONG, Lucie RASCLE, Roberto RIVA, Françis TURJMAN, Morgane LAUBACHER, Mehdi BEYRAGUED, Yves BERTHEZENE, Marc HERMIER, Ameli ROXANNA, Alexandre BANI-SADR, Andrea FILIP, Matteo CAPPUCCI, Laurent DEREX, PERNOT Pierre, CLOTTES Paul 004-Nantes Romain BOURCIER, Benjamin DAUMAS DUPORT, Pierre Louis ALEXANDRE, Hubert DESAL, Solene DE GAALON, Benoît GUILLON, Cécile PRETERRE, Guillaume TESSIER, Arthur LIONNET005-Nancy Benjamin GORY, Lisa HUMBERTJEAN-SELTON, René ANXIONNAT, Anne-Laure DERELLE, Liang LIAO, Emmanuelle SCHMITT, Sophie PLANEL, Sébastien RICHARD, Gioia MIONE, Jean-Christophe LACOUR, Marian DOUARINOU, Emilien MICARD, Bailiang CHEN, Gérard AUDIBERT, Agnès MASSON, Lionel ALB, Marine BEAUMONT, Adriana TABARNA, Marcela VOICU, Grégoire BARTHEL, Iona PODAR, Madalina BREZEANU, Marie REITTER, François ZHU, ANXIONNAT René006-Bordeaux Gaultier MARNAT, Jean-Sébastien LIEGEY, Pierre BRIAU, Victoire LYON, Igor SIBON, Xavier BARREAU, Jean PAPAXANTHOS, Jerome BERGE, Sabrina DEBRUXELLES, Stéphane OLINDO, Mathilde POLI, Pauline RENOU, Sharmila SAGNIER, Thomas TOURDIAS, Thomas COURRET, Malgorzata MILNEROWICZ, François ROUANET, Benoit LEGGHE, Aurelie BOYER, Tristan KERDRAON, Lisa SALEILLE, Laurine BASTARDO007-MontpellierCyril DARGAZANLI, Vincent COSTALAT, CAGNAZZO Federico, Pierre-Henri LEFEVRE, Grégory GASCOUQuentin VARNIER, François Louis COLLEMICHE, Isabelle MOURAND, Caroline ARQUIZANLucas CORTI, Adrien TER SCHIPHORST, Imad DERRAZ.008-Kremlin Bicêtre Laurent SPELLE, Jildaz CAROFF, Christian DENIER, Vanessa CHALUMEAU, Cristian MIHALEA, Nicolas LEGRIS, Augustin OZANNE, Leon IKKA, Olivier CHASSIN, Sophie GALLAS, Laura VENDITTI, Mariana SAROV, Jonathan CORTESE009-Rennes Jean-Christophe FERRE, Stephane VANNIER, Maria Veronica LASSALLE, Jean-Yves GAUVRIT, Clément TRACOL, Cécile MALRAIN, Edouard BEAUFRETON, Quentin ALIAS, Julien HISSIER, Maud GUILLEN, François EUGENE, BOUCHERIT Julien010-AmiensCyril CHIVOT, Audrey COURSELLE, Sandrine CANAPLE, Chantal LAMY, Kevin DELAFORGE, Manuel FERNANDEZ, Jérémie VIAL, Quentin LAFERTE, Xavier DESDOIT011-BrestSerge TIMSIT, Aurore JOURDAIN, Jean-Christophe GENTRIC, Julien OGNARD, Dr CHEDDAD EL AOUNI Mourad, Irina VIAKHIREVA, Jordan CORIS, François-Mathias MERRIEN, Denis MARECHAL, Marie BRUGUET, Philippe GOAS,012-CaenMarion BOULANGER, Emmanuel TOUZE, Charlotte BARBIER, Romain SCHNECKENBURGER,Julien COGEZ, Sophie GUETTIER, Estelle LA PORTE, Jean BOUCHART,Mohammad ISMAIL013-LimogesCharbel MOUNAYER, Aymeric ROUCHAUD, Suzana SALEME, Géraud FORESTIER,014-Pitié-SalpêtrièreSonia ALAMOWITCH, Charlotte ROSSO, Sara LEDER,Flore BARONNET, Sophie CROZIER,AnneLEGER, Laure BOTTIN, Sam GHAZANFARI,Marion YGER, Stephen DELORME,AymericWITTWER,Christine VASSILEV,Gaparad GERSCHENFELD, Clémence BLANC, Antonio RAINONE, Frédéric CLARENÇON, Kevin PREMAT, SHOTAREimad, StéphanieLENCK, Nader SOUROUR,ALLARD Julien,CHIARONI Pierre Marie.016-Ste AnneOlivier NAGGARA, Guillaume TURC, Wagih BEN HASSEN, Denis TRYSTRAM, Christine RODRIGUEZREGENT, FINOANA LAZA-NOMENJANAHARY,Hugo GORTAIS017-RouenOzlem OZKUL-WERMESTER, Chrysanthi PAPAGIANNAKI, Evelyne MASSARDIER, Aude TRIQUENOT, Margaux LEFEBVRE, Julien BUREL, BASILLE Florian, Adelya CURADO018-ToulouseAlain VIGUIER, Christophe COGNARD, Anne Christine JANUEL, Jean-François ALBUCHER, Lionel CALVIERE, Jean-Marc OLIVOT, Nicolas RAPOSO, Fabrice BONNEVILLE, Guillaume BELLANGER, Louis FONTAINE, Philippe TALL, Federico SACCHETTI019-BayonneFrédéric BOURDAIN, Patricia BERNADY, Guillaume BALLAN, Stephanie BANNIER, Emmanuel ELLIE, Olivier FLABEAU, Julia POTENZA, Antoine SOULAGES, Laurent LAGOARDE-SEGOT, Hélène CAILLIEZ, Louis VEUNAC, David HIGUE, Quentin BOURGEOIS-BEAUVAIS020-VannesAnthony LEBRAS, Sarah ADAM, Benoit PEGAT, Arnaud LE GUEN, François CHEDEVILLE, Jérémy JOUAN Rémi ALLIBERT, Alexandre COURTOIS, Lucile LESCOT, Dorothée VIDET, Thibaut LAPOTRE021-PauJohann Sebastian RICHTER, Bruno Thierry BARROSO, Camille DAHAN, Alexis GONNET, Régis HUBRECHT, Zoé LEPINE, Hélène CASTAGNET, Raluca MARASESCU022-Grenoble Olivier HECK, Pauline CUISENIER, Olivier DETANTE, Isabelle FAVRE WIKI, Clémentine BONAZ, GARAMBOIS Katia, Loic LEGRIS, Adrian KASTLER, Kamel BOUBAGRA, Corentin BERTHET, Stéphane Charara,Florent LEPILLIET23-Poitiers :Victor DUMAS, NEAU Jean Philippe, VELASCO Stéphane, NASR Nathalie.024-StrasbourgValérie WOLFF, Raoul POP, Véronique QUENARDELLE, Valérie LAUER, Irène PIERRE-PAUL, Roxana GHEOCA, Leonard LORANT026-ReimsSolène MOULIN, HUA Vi Tuan, Paolo PAGANO, Alexandre DOUCET, Christophe GELMINI, PierreFrançois MANCEAU, Laurenti PAIUSAN, Isabelle SERRE, Sébastien SOIZE, Thi Ngoc Phuong NGUYEN, Maher SAHNOUN, Nathalie CAUCHETEUX27-Colmar :Pablo LEBEDINSKY, FedericoBOLOGNINI, Francis VUILLEMET.028-Clermont-FerrandAnna FERRIER, Abderrahim ZERROUG, Ricardo MORENO, Emmanuel CHABERT, Elie LTEIF, Pauline PARIS, Nathalie BOURGOIS, Marie RAQUIN029-Angers Anne PASCO-PAPON, Jean Baptiste GIROT, Alderic LECLUSE, Sophie GODARD, Vincent L’ALLINEC, CORFU Alice,030-Tours Kevin JANOT, Richard BIBI, Marie GAUDRON, Arnaud BRETONNIERE, Mariam ANNAN, HéloïseIFERGAN, Grégoire BOULOUIS, Marco PASI,Séverine DEBIAIS, Elisabeth MOLINIER, DenisHERBRETEAU,Fouzi BALA, Clémence HOCHE032-Bar le DucAnthony WIETRICH, Valérie RUCHE, Karine LAVANDIER, Hakim AMARA033-Dijon Yannick BEJOT, Brivael LEMOGNE, Frédéric RICOLFI, Laura BAPTISTE, Pierre THOUANT, Gaulthier DULOQUIN, Pierre olivier COMBY, Blanc-Labarre Christelle, AMARAL Simon, BERNARD Angélique CHAVENT Adrien, RHAMANI Alan, CHEVALIER Corinne034-BesançonGuillaume CHARBONNIER, Louise BONNET, Nicolas RAYBAUD, Benjamin BOUAMRA, Thierry MOULIN, Alessandra BIONDI,035 -Versailles PICO Fernando, DANO Benjamin, PATCAS Carmen, CHAARI Dhouha, STANCIU Daniela, DUONG Duc Long, HMIDA Intissar, Marie-Laure CHADENAT037- Marseille SUISSALaurent, DOCHEEmilie, HAK Jean-François, REYREAnthony, CARLEXavier, LAKSIRI Nadia, OSMANO phélie, PERES Roxane, ROBINET-BORGMANO Emmanuelle, DULAU Cécile, KERLEROUX Basile, REY Caroline, BRUNEL Hervé DORY-LAUTREC Philippe, HAK Jean-François, LEHMANN Pierre VINGADALASSALOM Sivadji038-BASTIABasile KERLEROUX, Jérôme BERGE, Federico SACCHETTI040-ANNECYFabrice BING, Mathieu BONNEROT, BERGER Isabelle, MOREL Nathalie, RODIER Gilles, VADOT Wilfried.

        • Contributors Author Contributions: B.G. contributed to the conception and design of the study and is the overall guarantor. Y.D., I.D., S.F., J.C., R.B., S.S., S.M., S.R., G.M., M.H., C.C., J.P.D., M.A., J.M.O., B.C., A.C., B.L., B.G., all contributed to the acquisition and analysis of data. Y.D., S.F. and B.G., contributed to drafting the text and preparing the figures.Y.D., S.F. and B.G., contributed to drafting the text and preparing the figures.

        • 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 Dr. Marnat reports consulting fees from Microvention and Stryker outside the submitted work. Dr. Soize reports personal fees from Balt and Microvention outside the submitted work. Dr. Richard reports consulting fees from Stryker and Microvention outside the submitted work. Dr. Bourcier reports consulting fees from ACTICOR and payments for lectures from ACTICOR, BMS, Pfizer, and Bayer outside the submitted work. Dr. Casolla reports consulting fees from ACTICOR and payments for lectures from ACTICOR, BMS, Pfizer, and Bayer outside the submitted work. The other authors report no conflicts.

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

        • 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.