A randomized pilot study of patients with tandem carotid lesions undergoing thrombectomy - 04/10/19
This article has been published in an issue click here to access
Graphical abstract |
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. |
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.
Clinical Trial Registration |
URL: www.clinicaltrials.gov/. Unique identifier: NCT02157532.
El texto completo de este artículo está disponible en PDF.Keywords : Acute stroke, Carotid artery narrowing, Thrombectomy, Randomized controlled trial, Tandem lesion, Carotid artery stenting
Esquema
Bienvenido a EM-consulte, la referencia de los profesionales de la salud.
El acceso al texto completo de este artículo requiere una suscripción.
¿Ya suscrito a @@106933@@ revista ?