RT Journal Article
SR Electronic
T1 Management and outcome of patients with acute ischemic stroke and tandem carotid occlusion in the ESCAPE-NA1 trial
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP neurintsurg-2021-017474
DO 10.1136/neurintsurg-2021-017474
A1 Martha Marko
A1 Petra Cimflova
A1 Alexandre Y Poppe
A1 Nima Kashani
A1 Nishita Singh
A1 Johanna Ospel
A1 Arnuv Mayank
A1 Brian van Adel
A1 Ryan A McTaggart
A1 Raul G Nogueira
A1 Andrew M Demchuk
A1 Jeremy L Rempel
A1 Manish Joshi
A1 Charlotte Zerna
A1 Bijoy K Menon
A1 Michael Tymianski
A1 Michael D Hill
A1 Mayank Goyal
A1 Mohammed A Almekhlafi
A1 ,
YR 2021
UL http://jnis.bmj.com/content/early/2021/05/04/neurintsurg-2021-017474.abstract
AB Background The optimal treatment and prognosis for stroke patients with tandem cervical carotid occlusion are unclear. We analyzed outcomes and treatment strategies of tandem occlusion patients in the ESCAPE-NA1 trial.Methods ESCAPE-NA1 was a multicenter international randomized trial of nerinetide versus placebo in 1105 patients with acute ischemic stroke who underwent endovascular treatment. We defined tandem occlusions as complete occlusion of the cervical internal carotid artery (ICA) on catheter angiography, in addition to a proximal ipsilateral intracranial large vessel occlusion. Baseline characteristics and outcome parameters were compared between patients with tandem occlusions versus those without, and between patients with tandem occlusion who underwent ICA stenting versus those who did not. The influence of tandem occlusions on functional outcome was analyzed using multivariable regression modeling.Results Among 115/1105 patients (10.4%) with tandem occlusions, 62 (53.9%) received stenting for the cervical ICA occlusion. Of these, 46 (74.2%) were stented after and 16 (25.8%) before the intracranial thrombectomy. A modified Rankin Score (mRS) of 0–2 at 90 days was achieved in 82/115 patients (71.3%) with tandem occlusions compared with 579/981 (59.5%) patients without tandem occlusions. Tandem occlusion did not impact functional outcome in the adjusted analysis (OR 1.5, 95% CI 0.95 to 2.4). Among the subgroup of patients with tandem occlusion, cervical carotid stenting was not associated with different outcomes compared with no stenting (mRS 0–2: 75.8% vs 66.0%, adjusted OR 2.0, 95% CI 0.8 to 5.1).Conclusions Tandem cervical carotid occlusion in patients with acute large vessel stroke did not lower the odds of good functional outcome in our study. Functional outcomes were similar irrespective of the management of the cervical ICA occlusion (stenting vs not stenting).Access to data from the ESCAPE-NA1 trial supporting these findings is planned for the future but is not currently publicly available