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Mechanical Thrombectomy in Acute Occlusion of the Carotid-T: A Retrospective Single Centre Study in 51 Patients

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Abstract

Background and Purpose

Acute occlusion of the carotid-T is associated with large ischemic lesions, poor outcome and up to 53 % mortality with conservative therapy. Endovascular mechanical thrombectomy (EMT) is a promising alternative treatment of large vessel occlusion. Here, we examine feasibility, safety and efficiency of EMT in acute ischemic stroke due to carotid-T-occlusion.

Methods

Single centre, retrospective analysis of 51 consecutive patients with acute occlusion of the carotid-T, treated by EMT within 6 h after symptom onset. Most patients (42/51) were treated with stentretrievers, 33 with stentretrievers only. Recanalization was assessed by the Thrombolysis in Cerebral Infarction (TICI) score. Early and mid-term clinical outcome was evaluated by National Institutes of Health Stroke Scale (NIHSS)- and modified Rankin Scale mRS-scores, respectively.

Results

Successful recanalization (TICI 2b/3) was achieved in 78.4 % (40/51). Good clinical outcome (mRS 0–2) was observed in 24.4 % of patients, and only in patients treated successfully (TICI 2b/3). Stentretrievers yielded higher recanalization rates and better clinical outcomes than non-stentretriever devices. A total of 12 patients died (29.3 %) during the 90-day observation period. Clinically relevant procedure-related complications occurred in two patients, consisting in one vessel perforation with a microwire, and one symptomatic parenchymal haemorrhage after initiation of antiplatelet therapy following the inadvertent detachment of a stentretriever. Another symptomatic haemorrhage, not directly procedure-related, occurred in one additional patient.

Conclusion

EMT in acute carotid-T-occlusion is efficient, yielding high recanalization rates, and reasonably safe, with a low rate of clinically relevant complications. Successful recanalization seems to be a prerequisite for good clinical outcome in this severe condition.

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References

  1. Jansen O, von Kummer R, Forsting M, Hacke W, Sartor K. Thrombolytic therapy in acute occlusion of the intracranial internal carotid artery bifurcation. AJNR Am J Neuroradiol. 1995;16(10):1977–86.

    CAS  PubMed  Google Scholar 

  2. Wunderlich MT, Stolz E, Seidel G, Postert T, Gahn G, Sliwka U, et al. Conservative medical treatment and intravenous thrombolysis in acute stroke from carotid T occlusion. Cerebrovasc Dis. 2005;20(5):355–61. (doi:10.1159/000088063).

    Article  CAS  PubMed  Google Scholar 

  3. Georgiadis D, Oehler J, Schwarz S, Rousson V, Hartmann M, Schwab S. Does acute occlusion of the carotid T invariably have a poor outcome? Neurology. 2004;63(1):22–6.

    Article  CAS  PubMed  Google Scholar 

  4. Rha JH, Saver JL. The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke. 2007;38(3):967–73. (doi:10.1161/01.STR.0000258112.14918.24).

    Article  PubMed  Google Scholar 

  5. Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med. 1995;333(24):1581–7. (doi:10.1056/NEJM199512143332401).

  6. Hacke W, Kaste M, Fieschi C, von Kummer R, Davalos A, Meier D, et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet. 1998;352(9136):1245–51.

    Article  CAS  PubMed  Google Scholar 

  7. Fieschi C, Hacke W, Kaste M, Toni D, Lesaffre E. Thrombolytic therapy for acute ischaemic stroke. ECASS Study Group. Lancet. 1997;350(9089):1476; author reply 7.

    Article  CAS  PubMed  Google Scholar 

  8. Mattle HP, Arnold M, Georgiadis D, Baumann C, Nedeltchev K, Benninger D, et al. Comparison of intraarterial and intravenous thrombolysis for ischemic stroke with hyperdense middle cerebral artery sign. Stroke. 2008;39(2):379–83. (doi:10.1161/STROKEAHA.107.492348).

    Article  PubMed  Google Scholar 

  9. Fischer U, Arnold M, Nedeltchev K, Brekenfeld C, Ballinari P, Remonda L, et al. NIHSS score and arteriographic findings in acute ischemic stroke. Stroke. 2005;36(10):2121–5. (doi:10.1161/01.STR.0000182099.04994.fc).

    Article  PubMed  Google Scholar 

  10. Beck C, Cheng B, Krutzelmann A, Rosenkranz M, Gerloff C, Fiehler J, et al. Outcome of MRI-based intravenous thrombolysis in carotid-T occlusion. J Neurol. 2012;259:2141–6. (doi:10.1007/s00415–012-6472-z).

    Article  PubMed  Google Scholar 

  11. del Zoppo GJ, Poeck K, Pessin MS, Wolpert SM, Furlan AJ, Ferbert A, et al. Recombinant tissue plasminogen activator in acute thrombotic and embolic stroke. Ann Neurol. 1992;32(1):78–86. (doi:10.1002/ana.410320113).

    Article  PubMed  Google Scholar 

  12. Bhatia R, Hill MD, Shobha N, Menon B, Bal S, Kochar P, et al. Low rates of acute recanalization with intravenous recombinant tissue plasminogen activator in ischemic stroke: real-world experience and a call for action. Stroke. 2010;41(10):2254–8. (doi:10.1161/STROKEAHA.110.592535).

    Article  CAS  PubMed  Google Scholar 

  13. Smith WS, Sung G, Saver J, Budzik R, Duckwiler G, Liebeskind DS, et al. Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial. Stroke. 2008;39(4):1205–12.

    Article  PubMed  Google Scholar 

  14. Smith WS. Safety of mechanical thrombectomy and intravenous tissue plasminogen activator in acute ischemic stroke. Results of the multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI) trial, part I. AJNR Am J Neuroradiol. 2006;27(6):1177–82.

    CAS  PubMed  Google Scholar 

  15. Penumbra Pivotal Stroke Trial Investigators. The penumbra pivotal stroke trial: safety and effectiveness of a new generation of mechanical devices for clot removal in intracranial large vessel occlusive disease. Stroke. 2009;40(8):2761–8.

    Article  Google Scholar 

  16. Perez MA, Miloslavski E, Fischer S, Bazner H, Henkes H. Intracranial thrombectomy using the Solitaire stent: a historical vignette. J Neurointerv Surg. 2012;4:e32. (doi:10.1136/neurintsurg-2011–010149).

    Article  PubMed  PubMed Central  Google Scholar 

  17. Flint AC, Duckwiler GR, Budzik RF, Liebeskind DS, Smith WS. Mechanical thrombectomy of intracranial internal carotid occlusion: pooled results of the MERCI and Multi MERCI Part I trials. Stroke. 2007;38(4):1274–80.

    Article  PubMed  Google Scholar 

  18. Watanabe M, Mori T, Imai K, Izumoto H. Endovascular interventions for patients with serious symptoms caused by embolic carotid T occlusion. Neurol Med Chir. 2011;51(4):282–8.

    Article  Google Scholar 

  19. Fesl G, Wiesmann M, Patzig M, Holtmannspoetter M, Pfefferkorn T, Dichgans M, et al. Endovascular mechanical recanalisation of acute carotid-T occlusions: a single-center retrospective analysis. Cardiovasc Intervent Radiol. 2011;34(2):280–6. (doi:10.1007/s00270-010-9980-1).

    Article  PubMed  Google Scholar 

  20. Lin R, Vora N, Zaidi S, Aleu A, Jankowitz B, Thomas A, et al. Mechanical approaches combined with intra-arterial pharmacological therapy are associated with higher recanalization rates than either intervention alone in revascularization of acute carotid terminus occlusion. Stroke. 2009;40(6):2092–7. (doi:10.1161/STROKEAHA.108.544783).

    Article  PubMed  Google Scholar 

  21. Galimanis A, Jung S, Mono ML, Fischer U, Findling O, Weck A, et al. Endovascular therapy of 623 patients with anterior circulation stroke. Stroke. 2012;43(4):1052–7. (doi:10.1161/STROKEAHA.111.639112).

    Article  PubMed  Google Scholar 

  22. Higashida RT, Furlan AJ, Roberts H, Tomsick T, Connors B, Barr J, et al. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke. 2003;34(8):e109–37. (doi:10.1161/01.STR.0000082721.62796.09).

    Article  PubMed  Google Scholar 

  23. Fischer U, Mono ML, Schroth G, Jung S, Mordasini P, El-Koussy M, et al. Endovascular therapy in 201 patients with acute symptomatic occlusion of the internal carotid artery. Eur J Neurol. 2013;20(7):1017–24, e87. (doi:10.1111/ene.12094).

    Article  CAS  PubMed  Google Scholar 

  24. Nogueira RG, Lutsep HL, Gupta R, Jovin TG, Albers GW, Walker GA, et al. Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial. Lancet. 2012;380(9849):1231–40. (doi:10.1016/S0140-6736(12)61299-9).

    Article  PubMed  PubMed Central  Google Scholar 

  25. Saver JL, Jahan R, Levy EI, Jovin TG, Baxter B, Nogueira R, et al. SOLITAIRE with the intention for thrombectomy (SWIFT) trial: design of a randomized, controlled, multicenter study comparing the SOLITAIRE Flow Restoration device and the MERCI Retriever in acute ischaemic stroke. Int J Stroke. 2014;9:658–68. (doi:10.1111/j.1747-4949.2012.00856.x).

    Article  CAS  PubMed  Google Scholar 

  26. Pereira VM, Gralla J, Davalos A, Bonafe A, Castano C, Chapot R, et al. Prospective, multicenter, single-arm study of mechanical thrombectomy using Solitaire Flow Restoration in acute ischemic stroke. Stroke. 2013;44(10):2802–7. (doi:10.1161/STROKEAHA.113.001232).

    Article  PubMed  PubMed Central  Google Scholar 

  27. Castano C, Dorado L, Guerrero C, Millan M, Gomis M, Perez de la Ossa N, et al. Mechanical thrombectomy with the Solitaire AB device in large artery occlusions of the anterior circulation: a pilot study. Stroke. 2010;41(8):1836–40. (doi:10.1161/STROKEAHA.110.584904).

    Article  PubMed  Google Scholar 

  28. Riedel CH, Zimmermann P, Jensen-Kondering U, Stingele R, Deuschl G, Jansen O. The importance of size: successful recanalization by intravenous thrombolysis in acute anterior stroke depends on thrombus length. Stroke. 2011;42(6):1775–7. (doi:10.1161/STROKEAHA.110.609693).

    Article  PubMed  Google Scholar 

  29. Saqqur M, Uchino K, Demchuk AM, Molina CA, Garami Z, Calleja S, et al. Site of arterial occlusion identified by transcranial Doppler predicts the response to intravenous thrombolysis for stroke. Stroke. 2007;38(3):948–54. (doi:10.1161/01.STR.0000257304.21967.ba).

    Article  PubMed  Google Scholar 

  30. Smith WS, Sung G, Starkman S, Saver JL, Kidwell CS, Gobin YP et al. Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial. Stroke. 2005;36(7):1432–8.

    Article  PubMed  Google Scholar 

  31. Weimar C, Konig IR, Kraywinkel K, Ziegler A, Diener HC. Age and National Institutes of Health Stroke Scale Score within 6 hours after onset are accurate predictors of outcome after cerebral ischemia: development and external validation of prognostic models. Stroke. 2004;35(1):158–62. (doi:10.1161/01.STR.0000106761.94985.8B).

    Article  CAS  PubMed  Google Scholar 

  32. Arnold M, Nedeltchev K, Mattle HP, Loher TJ, Stepper F, Schroth G, et al. Intra-arterial thrombolysis in 24 consecutive patients with internal carotid artery T occlusions. J Neurol Neurosurg Psychiatry. 2003;74(6):739–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgment

Thanks to Mr. Haller from the statistics department, Technical University Munich.

Disclosures

None.

Conflict of Interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany

    Daniela Frahm, Mirjam I. Schubert, Justus F. Kleine & Sascha Prothmann

  2. Klinikum rechts der Isar, Neurological Clinic and Policlinic, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany

    Silke Wunderlich & Holger Poppert

Authors
  1. Daniela Frahm
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  2. Silke Wunderlich
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Corresponding author

Correspondence to Justus F. Kleine.

Additional information

Justus F. Kleine and Sascha Prothmann contributed equally to this work.

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Frahm, D., Wunderlich, S., Schubert, M. et al. Mechanical Thrombectomy in Acute Occlusion of the Carotid-T: A Retrospective Single Centre Study in 51 Patients. Clin Neuroradiol 26, 23–29 (2016). https://doi.org/10.1007/s00062-014-0322-6

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  • DOI: https://doi.org/10.1007/s00062-014-0322-6

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