RT Journal Article
SR Electronic
T1 Carotid artery direct access for mechanical thrombectomy: the Carotid Artery Puncture Evaluation (CARE) study
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 1180
OP 1185
DO 10.1136/neurintsurg-2021-017935
VO 14
IS 12
A1 Victor Dumas
A1 Johannes Kaesmacher
A1 Julien Ognard
A1 Géraud Forestier
A1 Cyril Dargazanli
A1 Kevin Janot
A1 Daniel Behme
A1 Eimad Shotar
A1 Emmanuel Chabert
A1 Stéphane Velasco
A1 Nicolas Bricout
A1 Wagih Ben Hassen
A1 Louis Veunac
A1 Maxime Geismar
A1 Francois Eugene
A1 Lili Detraz
A1 Jean Darcourt
A1 Vincent L'Allinec
A1 Omer F Eker
A1 Arturo Consoli
A1 Volker Maus
A1 Florent Gariel
A1 Gaultier Marnat
A1 Panagiotis Papanagiotou
A1 Chrisanthi Papagiannaki
A1 Simon Escalard
A1 Lukas Meyer
A1 Donald Lobsien
A1 Nuran Abdullayev
A1 Vanessa Chalumeau
A1 Jean Philippe Neau
A1 Rémy Guillevin
A1 Gregoire Boulouis
A1 Aymeric Rouchaud
A1 Hanna Styczen
A1 Cédric Fauché
A1 ,
YR 2022
UL http://jnis.bmj.com/content/14/12/1180.abstract
AB Background In acute ischemic stroke due to anterior large vessel occlusion (AIS-LVO), accessing the target occluded vessel for mechanical thrombectomy (MT) is sometimes impossible through the femoral approach. We aimed to evaluate the safety and efficacy of direct carotid artery puncture (DCP) for MT in patients with failed alternative vascular access.Methods We retrospectively analyzed data from 45 stroke centers in France, Switzerland and Germany through two research networks from January 2015 to July 2019. We collected physician-centered data on DCP practices and baseline characteristics, procedural variables and clinical outcome after DCP. Uni- and multivariable models were conducted to assess risk factors for complications.Results From January 2015 to July 2019, 28 149 MT were performed, of which 108 (0.39%) resulted in DCP due to unsuccessful vascular access. After DCP, 77 patients (71.3%) had successful reperfusion (modified Thrombolysis In Cerebral Infarction (mTICI) score ≥2b) and 28 (25.9%) were independent (modified Rankin Scale (mRS) score 0–2) at 3 months. 20 complications (18.5%) attributed to DCP occurred, all of them during or within 1 hour of the procedure. Complications led to extension of the intubation time in the intensive care unit in 7 patients (6.4%) and resulted in death in 3 (2.8%). The absence of use of a hemostatic closure device was associated with a higher complication risk (OR 3.04, 95% CI 1.03 to 8.97; p=0043).Conclusion In this large multicentric study, DCP was scantly performed for vascular access to perform MT (0.39%) in patients with AIS-LVO and had a high rate of complications (18.5%). Our results provide arguments for not closing the cervical access by manual compression after MT.All data relevant to the study are included in the article or uploaded as supplementary information.