RT Journal Article
SR Electronic
T1 Rescue carotid puncture for ischemic stroke treated by endovascular therapy: a multicentric analysis and systematic review
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 809
OP 815
DO 10.1136/neurintsurg-2020-016725
VO 13
IS 9
A1 Julien Allard
A1 Sam Ghazanfari
A1 Mehdi Mahmoudi
A1 Julien Labreuche
A1 Simon Escalard
A1 François Delvoye
A1 Gabriele Ciccio
A1 Stanislas Smajda
A1 Hocine Redjem
A1 Solène Hebert
A1 Arturo Consoli
A1 Vincent Costalat
A1 Jean-Philippe Desilles
A1 Mikael Mazighi
A1 Michel Piotin
A1 Cyril Dargazanli
A1 Bertrand Lapergue
A1 Raphaël Blanc
A1 Benjamin Maïer
YR 2021
UL http://jnis.bmj.com/content/13/9/809.abstract
AB 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.Data are available upon reasonable request.