A randomized pilot study of patients with tandem carotid lesions undergoing thrombectomy - 04/10/19

Doi : 10.1016/j.neurad.2019.08.003

Alexandre Y. Poppe ^a,^c,^d,⁎ , Grégory Jacquin ^a,^c,^d, Christian Stapf ^a,^c,^d, Nicole Daneault ^a,^c,^d, Yan Deschaintre ^a,^c,^d, Laura C. Gioia ^a,^c,^d, Céline Odier ^a,^c,^d, Marilyn Labrie ^a, Ahmad Nehme ^a, Lorena Nico ^b, Daniel Roy ^b,^c, Alain Weill ^b,^c, Jean Raymond ^b,^c
^a Division of Neurology, Centre Hospitalier de l’Université de Montréal, 900, rue St-Denis, R04-758 H2X 0A9 Montréal, Québec, Canada
^b Department of Radiology, Centre Hospitalier de l’Université de Montréal, 900, rue St-Denis, R04-758 H2X 0A9 Montréal, Québec, Canada
^c Neurovascular Group, Axe Neurosciences, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, 900, rue St-Denis, R04-758 H2X 0A9 Montréal, Québec, Canada
^d Department of Neurosciences, Faculté de Médecine, Université de Montréal, 900, rue St-Denis, R04-758 H2X 0A9 Montréal, Québec, Canada

^⁎Corresponding author. Centre Hospitalier de l’Université de Montréal, 900, rue St-Denis, R04-758 H2X 0A9 Montréal, Québec, Canada.Centre Hospitalier de l’Université de Montréal900, rue St-Denis, R04-758 Montréal, QuébecH2X 0A9Canada

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Graphical abstract

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Highlights

•	No randomized trial data exist to guide optimal acute treatment of patients with tandem carotid lesions.
•	This first randomized dataset shows no significant differences between acute stenting and no stenting.
•	A larger trial addressing acute management of patients with tandem carotid lesions is both feasible and necessary.

Le texte complet de cet article est disponible en PDF.

Abstract

Background and purpose

The optimal management of patients with tandem lesions (TL), or cervical internal carotid artery (c-ICA) steno-occlusive pathology and ipsilateral intracranial occlusion, who are undergoing endovascular thrombectomy (EVT) remains unknown. We sought to establish the feasibility of a trial designed to address this question.

Materials and methods

The Endovascular Acute Stroke Intervention (EASI) study was a single-centre randomized trial comparing EVT to medical therapy for large-vessel occlusion stroke. Patients with TL receiving EVT were randomly allocated to acute c-ICA stenting or no stenting. The primary outcome was the proportion of patients with a modified Rankin Scale (mRS) score of 0–2 at 90 days. Safety outcomes were symptomatic intracranial hemorrhage (sICH) at 24hours and mortality at 90 days.

Results

Of 301 patients included in EASI between 2013 and 2018, 24 (8.0%) with TL were randomly allocated to acute stenting (n=13) or no stenting (n=11). Baseline characteristics were balanced. Eight (61.5%; 95% CI 35.5%–82.3%) and 7 (63.6%; 95% CI 35.4%–84.9%) patients, respectively, had a favorable outcome (mRS 0–2; P=1.0). One non-stented patient had a symptomatic intracerebral hemorrhage.

Conclusions

This pilot trial of patients with TL undergoing EVT suggests that a sufficiently powered larger TL trial comparing acute c-ICA stenting to no stenting is feasible.