PT  - JOURNAL ARTICLE
AU  - D. Behme
AU  - A. Mpotsaris
AU  - P. Zeyen
AU  - M.N. Psychogios
AU  - A. Kowoll
AU  - C.J. Maurer
AU  - F. Joachimski
AU  - J. Liman
AU  - K. Wasser
AU  - C. Kabbasch
AU  - A. Berlis
AU  - M. Knauth
AU  - T. Liebig
AU  - W. Weber
TI  - Emergency Stenting of the Extracranial Internal Carotid Artery in Combination with Anterior Circulation Thrombectomy in Acute Ischemic Stroke: A Retrospective Multicenter Study
AID  - 10.3174/ajnr.A4459
DP  - 2015 Aug 20
TA  - American Journal of Neuroradiology
4099  - http://www.ajnr.org/content/early/2015/08/20/ajnr.A4459.short
4100  - http://www.ajnr.org/content/early/2015/08/20/ajnr.A4459.full
AB  - BACKGROUND AND PURPOSE: Several small case series reported a favorable clinical outcome for emergency stent placement in the extracranial internal carotid artery combined with mechanical thrombectomy in acute stroke. The rate of postinterventional symptomatic intracranial hemorrhages was reported to be as high as 20%. Therefore, we investigated the safety and efficacy of this technique in a large multicentric cohort.MATERIALS AND METHODS: The data bases of 4 German stroke centers were screened for all patients who received emergency stent placement of the extracranial internal carotid artery in combination with mechanical thrombectomy of the anterior circulation between 2007 and 2014. The primary outcome measure was the rate of symptomatic intracranial hemorrhage according to the European Cooperative Acute Stroke Study III criteria; secondary outcome measures included the angiographic revascularization results and clinical outcome.RESULTS: One hundred seventy patients with a median age of 64 years (range, 25–88 years) were treated. They presented after a median of 98 minutes (range, 52–160 minutes) with a median NIHSS score of 15 (range, 12–19). Symptomatic intracranial hemorrhages occurred in 15/170 (9%) patients; there was no statistically significant difference among groups pertaining to age, sex, intravenous rtPA, procedural timings, and the rate of successful recanalization. In 130/170 (77%) patients, a TICI score of ≥2b could be achieved. The in-hospital mortality rate was 19%, and 36% of patients had a favorable outcome at follow-up.CONCLUSIONS: Emergency stent placement in the extracranial internal carotid artery in combination with anterior circulation thrombectomy is effective and safe. It is not associated with a significantly higher risk of symptomatic intracranial hemorrhage compared with published series for mechanical thrombectomy alone.AbbreviationsPHparenchymal hematomasICHsymptomatic intracranial hemorrhage