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Original research
Safety of acute internal carotid artery stenting during endovascular thrombectomy in patients with acute ischemic stroke: a retrospective analysis of the OPTIMISE registry
  1. George Nilton Mendes1,2,
  2. Grégory Jacquin1,2,
  3. Aristeidis H Katsanos3,
  4. Nishita Singh4,
  5. Grant Stotts5,6,
  6. Darren B Ferguson7,
  7. Samuel Yip8,
  8. Alexandre Y Poppe1,2
    1. 1Neurosciences Axis, Centre de Recherche du CHUM, Montreal, Quebec, Canada
    2. 2Neurosciences, Centre Hospitalier de L'Universite de Montreal, Montreal, Quebec, Canada
    3. 3Medicine (Neurology), McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
    4. 4Internal Medicine (Neurology), University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
    5. 5Medicine, University of Ottawa, Ottawa, Ontario, Canada
    6. 6Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
    7. 7Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
    8. 8Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada
    1. Correspondence to Dr Alexandre Y Poppe, Neurosciences, Centre Hospitalier de L'Universite de Montreal, Montreal, Quebec, H2X 0C1, Canada; alexandre.poppe.med{at}ssss.gouv.qc.ca

    Abstract

    Background The optimal management of tandem carotid lesions during endovascular thrombectomy (EVT) remains uncertain. The safety and efficacy of acute carotid artery stenting (aCAS) are debated, including safety concerns such as procedural complications and symptomatic intracerebral hemorrhage (sICH). We aimed to assess aCAS safety among EVT-treated patients using a large Canadian registry.

    Methods We retrospectively analyzed the OPTIMISE registry and compared adult patients undergoing EVT and aCAS versus EVT only. The primary outcome was a composite of in-hospital death, long-term care facility destination at discharge, sICH, or any EVT-related procedural complications. Secondary outcomes included individual components of the primary outcome, EVT workflow times, final modified Thrombolysis in Cerebral Ischemia score and 90-day modified Rankin Scale score. Statistical significance was evaluated by a multivariate logistic regression model.

    Results 4205 patients were included (330 with EVT-aCAS and 3875 with EVT-only). Both groups were similar with regard to baseline National Institutes of Health Stroke Scale score, Alberta Stroke Program Early CT Score and use of IV thrombolysis, but differed in age (EVT-aCAS group 67.2±12.1 years vs EVT-only group 71.3±14.1 years, P<0.001), proportion of women (28.2% vs 53.3%, P<0.001), and occlusion location (internal carotid artery terminus 44% vs 16%, P<0.001). The EVT-aCAS group showed a non-significant increase in odds of composite safety outcomes (adjusted OR 1.35 (95% CI 0.97 to 1.84), P=0.06) with a significantly higher proportion of procedural complications (10.0% vs 6.2%, P=0.002).

    Conclusion In a large national registry, EVT-aCAS was associated with a higher proportion of unfavorable safety outcomes, driven by more frequent procedural complications. Further research is needed to clarify the role of aCAS in tandem occlusion stroke.

    • Stroke
    • Thrombectomy
    • Stent
    • Stenosis

    Data availability statement

    The data that support the findings of this study are available from the corresponding author (AYP) upon reasonable request by a qualified investigator and after approval from the OPTIMISE steering committee. Data are available upon reasonable request by a qualified investigator.

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    Data availability statement

    The data that support the findings of this study are available from the corresponding author (AYP) upon reasonable request by a qualified investigator and after approval from the OPTIMISE steering committee. Data are available upon reasonable request by a qualified investigator.

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    Footnotes

    • X @georgemendesbr, @nishita_singh3

    • GNM and GJ contributed equally.

    • Contributors GNM helped conceive the study design, analyzed and interpreted the data and wrote initial drafts of the manuscript. GJ helped conceive the study design, performed the statistical analyses and provided critical review of the manuscript. AHK provided critical review of the manuscript and provided advice for statistical analyses. NS provided critical review of the manuscript. GS serves as leader of OPTIMISE and provided critical review of the manuscript. DBF provided critical review of the manuscript. SY provided critical review of the manuscript. AYP helped conceive the study design, supervised GNM, provided critical review of the manuscript, wrote the final draft and is guarantor for the study. All authors have given final approval of the manuscript and agree to be accountable for all aspects of the work.

    • Funding The current study was not funded. OPTIMISE was supported by a grant from Medtronic and by the Canadian Stroke Consortium.

    • Competing interests GNM reports no disclosures. GJ reports no disclosures. AHK reports no disclosures. NS reports a catalyst grant from Brain Canada and an endowed Chair from Heart and Stroke Research – Manitoba. GS reports no disclosures. DBF reports no disclosures. SY reports no disclosures. AYP reports research grants from Brain Canada, the Canadian Institutes for Health Research and Heart and Stroke Canada for the EASI-TOC trial of acute stenting in tandem lesion stroke, speaker’s honoraria from Roche Canada, safety committee participation for the AcT trial and being Chair of the Canadian Stroke Consortium National Stroke Fellowship program.

    • 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.