Acute Endovascular Treatment of Patients With lschemic Stroke From Intracranial Large Vessel Occlusion and Extracranial Carotid Dissection

Kars C. J. Compagne; R. B. Goldhoorn; Maarten Uyttenboogaart; Robert J. van Oostenbrugge; Wim H. van Zwam; Pieter J. van Doormaal; Diederik W. J. Dippel; Aad van der Lugt; Bart J. Emmer; Adriaan C. G. M. van Es; Charles B. L. M. Majoie; Yvo B. W. E. M. Roos; Jelis Boiten; Jan Albert Vos; Ivo G. H. Jansen; Maxim J. H. L. Mulder; Manon Kappelhof; Wouter J. Schonewille; Jonathan M. Coutinho; Marieke J. H. Wermer; Marianne A. A. van Walderveen; Julie Staals; Jeannette Hofmeijer; Jasper M. Martens; Geert J. Lycklama Nijeholt; Bob Roozenbeek; Sebastiaan F. de Bruijn; Lukas C. van Dijk; H. Bart van der Worp; Rob H. Lo; Ewoud J. van Dijk; Hieronymus D. Boogaarts; Paul L. M. de Kort; Jo J. P. Peluso; Jan S. P. van den Berg; Boudewijn A. A. M. van Hasselt; Leo A. M. Aerden; Ren J. Dallinga; Omid Eshghi; Tobien H. C. M. L. Schreuder; Roel J. J. Heijboer; Koos Keizer; Lonneke S. F. Yo; Heleen M. den Hertog; Emiel J. C. Sturm; Marieke E. S. Sprengers; Sjoerd F. M. Jenniskens; Rene van den Berg; Alida A. Postma; P. F. C. Groot; MR CLEAN Investigators

doi:10.3389/fneur.2019.00102

Acute Endovascular Treatment of Patients With lschemic Stroke From Intracranial Large Vessel Occlusion and Extracranial Carotid Dissection

Kars C. J. Compagne^*, R. B. Goldhoorn, Maarten Uyttenboogaart, Robert J. van Oostenbrugge, Wim H. van Zwam, Pieter J. van Doormaal, Diederik W. J. Dippel, Aad van der Lugt, Bart J. Emmer, Adriaan C. G. M. van Es, Charles B. L. M. Majoie, Yvo B. W. E. M. Roos, Jelis Boiten, Jan Albert Vos, Ivo G. H. Jansen, Maxim J. H. L. Mulder, Manon Kappelhof, Wouter J. Schonewille, Jonathan M. Coutinho, Marieke J. H. WermerMarianne A. A. van Walderveen, Julie Staals, Jeannette Hofmeijer, Jasper M. Martens, Geert J. Lycklama Nijeholt, Bob Roozenbeek, Sebastiaan F. de Bruijn, Lukas C. van Dijk, H. Bart van der Worp, Rob H. Lo, Ewoud J. van Dijk, Hieronymus D. Boogaarts, Paul L. M. de Kort, Jo J. P. Peluso, Jan S. P. van den Berg, Boudewijn A. A. M. van Hasselt, Leo A. M. Aerden, Ren J. Dallinga, Omid Eshghi, Tobien H. C. M. L. Schreuder, Roel J. J. Heijboer, Koos Keizer, Lonneke S. F. Yo, Heleen M. den Hertog, Emiel J. C. Sturm, Marieke E. S. Sprengers, Sjoerd F. M. Jenniskens, Rene van den Berg, Alida A. Postma, P. F. C. Groot, MR CLEAN Investigators

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Introduction: Carotid artery dissection (CAD) and atherosclerotic carotid artery occlusion (ACAO) are major causes of a tandem occlusion in patients with intracranial large vessel occlusion (LVO). Presence of tandem occlusions may hamper intracranial access and potentially increases the risk of procedural complications of endovascular treatment (EVT). Our aim was to assess neurological, functional and technical outcome and complications of EVT for intracranial LVO in patients with CAD in comparison to patients with ACAO and to patients without CAD or ACAO. Methods: We analyzed data of the MR CLEAN trial intervention arm and MR CLEAN Registry, acquired in 16 Dutch EVT-centers. Primary outcome was the change in stroke severity by comparing the National Institute of Health Stroke Scale (NIHSS) score at 24–48 h after treatment vs. baseline. Secondary outcomes included reperfusion rate and symptomatic intracranial hemorrhage (sICH). We compared outcomes and complications between patients with CAD vs. patients with ACAO and patients without CAD or ACAO. Results: In total, we identified 74 (4.7%) patients with CAD, 92 (5.9%) patients with ACAO and 1398 (89.4%) patients without CAD or ACAO. Neurological improvement at short-term after EVT in patients with CAD was significantly better compared to ACAO (resp. mean −5 vs. mean −1 NIHSS point; p = 0.03) and did not differ compared to patients without CAD or ACAO (−4 NIHSS points; p = 0.62). Rates of successful reperfusion in patients with CAD (47%) was comparable to patients with ACAO (47%; p = 1.00), but was less often achieved compared to patients without CAD or ACAO (58%; p = 0.08). Occurrence of sICH did not differ significantly between CAD patients (5%) and ACAO (11%; p = 0.33) or without CAD/ACAO (6%; p = 1.00). Conclusion: EVT in patients with intracranial LVO due to CAD results in neurological improvement comparable to patients without tandem occlusions. Therefore, carotid artery dissection by itself should not be a contraindication for endovascular treatment in stroke patients with intracranial large vessel occlusion. Although more challenging endovascular procedures are to be suspected in both patients with CAD or ACAO, accurate distinction between CAD and ACAO might influence clinical decision making as better clinical outcome can be expected in patients with CAD.

Original language	English
Article number	102
Pages (from-to)	1-9
Number of pages	9
Journal	Frontiers in Neurology
Volume	10
DOIs	https://doi.org/10.3389/fneur.2019.00102
Publication status	Published - 19 Feb 2019

Keywords

ischemic stroke
carotid dissection
endovascular treatment
tandem lesion
thrombectomy
ACUTE ISCHEMIC-STROKE
ARTERY DISSECTION
MECHANICAL THROMBECTOMY
INTRAARTERIAL TREATMENT
MANAGEMENT
REPERFUSION
SCORE

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Compagne, K. C. J., Goldhoorn, R. B., Uyttenboogaart, M., van Oostenbrugge, R. J., van Zwam, W. H., van Doormaal, P. J., Dippel, D. W. J., van der Lugt, A., Emmer, B. J., van Es, A. C. G. M., Majoie, C. B. L. M., Roos, Y. B. W. E. M., Boiten, J., Vos, J. A., Jansen, I. G. H., Mulder, M. J. H. L., Kappelhof, M., Schonewille, W. J., Coutinho, J. M., ... MR CLEAN Investigators (2019). Acute Endovascular Treatment of Patients With lschemic Stroke From Intracranial Large Vessel Occlusion and Extracranial Carotid Dissection. Frontiers in Neurology, 10, 1-9. Article 102. https://doi.org/10.3389/fneur.2019.00102

@article{4066f1412da04e0ab5aab6d2a0c6a9f1,

title = "Acute Endovascular Treatment of Patients With lschemic Stroke From Intracranial Large Vessel Occlusion and Extracranial Carotid Dissection",

abstract = "Introduction: Carotid artery dissection (CAD) and atherosclerotic carotid artery occlusion (ACAO) are major causes of a tandem occlusion in patients with intracranial large vessel occlusion (LVO). Presence of tandem occlusions may hamper intracranial access and potentially increases the risk of procedural complications of endovascular treatment (EVT). Our aim was to assess neurological, functional and technical outcome and complications of EVT for intracranial LVO in patients with CAD in comparison to patients with ACAO and to patients without CAD or ACAO. Methods: We analyzed data of the MR CLEAN trial intervention arm and MR CLEAN Registry, acquired in 16 Dutch EVT-centers. Primary outcome was the change in stroke severity by comparing the National Institute of Health Stroke Scale (NIHSS) score at 24–48 h after treatment vs. baseline. Secondary outcomes included reperfusion rate and symptomatic intracranial hemorrhage (sICH). We compared outcomes and complications between patients with CAD vs. patients with ACAO and patients without CAD or ACAO. Results: In total, we identified 74 (4.7%) patients with CAD, 92 (5.9%) patients with ACAO and 1398 (89.4%) patients without CAD or ACAO. Neurological improvement at short-term after EVT in patients with CAD was significantly better compared to ACAO (resp. mean −5 vs. mean −1 NIHSS point; p = 0.03) and did not differ compared to patients without CAD or ACAO (−4 NIHSS points; p = 0.62). Rates of successful reperfusion in patients with CAD (47%) was comparable to patients with ACAO (47%; p = 1.00), but was less often achieved compared to patients without CAD or ACAO (58%; p = 0.08). Occurrence of sICH did not differ significantly between CAD patients (5%) and ACAO (11%; p = 0.33) or without CAD/ACAO (6%; p = 1.00). Conclusion: EVT in patients with intracranial LVO due to CAD results in neurological improvement comparable to patients without tandem occlusions. Therefore, carotid artery dissection by itself should not be a contraindication for endovascular treatment in stroke patients with intracranial large vessel occlusion. Although more challenging endovascular procedures are to be suspected in both patients with CAD or ACAO, accurate distinction between CAD and ACAO might influence clinical decision making as better clinical outcome can be expected in patients with CAD.",

keywords = "ischemic stroke, carotid dissection, endovascular treatment, tandem lesion, thrombectomy, ACUTE ISCHEMIC-STROKE, ARTERY DISSECTION, MECHANICAL THROMBECTOMY, INTRAARTERIAL TREATMENT, MANAGEMENT, REPERFUSION, SCORE",

author = "Compagne, {Kars C. J.} and Goldhoorn, {R. B.} and Maarten Uyttenboogaart and {van Oostenbrugge}, {Robert J.} and {van Zwam}, {Wim H.} and {van Doormaal}, {Pieter J.} and Dippel, {Diederik W. J.} and {van der Lugt}, Aad and Emmer, {Bart J.} and {van Es}, {Adriaan C. G. M.} and Majoie, {Charles B. L. M.} and Roos, {Yvo B. W. E. M.} and Jelis Boiten and Vos, {Jan Albert} and Jansen, {Ivo G. H.} and Mulder, {Maxim J. H. L.} and Manon Kappelhof and Schonewille, {Wouter J.} and Coutinho, {Jonathan M.} and Wermer, {Marieke J. H.} and {van Walderveen}, {Marianne A. A.} and Julie Staals and Jeannette Hofmeijer and Martens, {Jasper M.} and Nijeholt, {Geert J. Lycklama} and Bob Roozenbeek and {de Bruijn}, {Sebastiaan F.} and {van Dijk}, {Lukas C.} and {van der Worp}, {H. Bart} and Lo, {Rob H.} and {van Dijk}, {Ewoud J.} and Boogaarts, {Hieronymus D.} and {de Kort}, {Paul L. M.} and Peluso, {Jo J. P.} and {van den Berg}, {Jan S. P.} and {van Hasselt}, {Boudewijn A. A. M.} and Aerden, {Leo A. M.} and Dallinga, {Ren J.} and Omid Eshghi and Schreuder, {Tobien H. C. M. L.} and Heijboer, {Roel J. J.} and Koos Keizer and Yo, {Lonneke S. F.} and {den Hertog}, {Heleen M.} and Sturm, {Emiel J. C.} and Sprengers, {Marieke E. S.} and Jenniskens, {Sjoerd F. M.} and {van den Berg}, Rene and Postma, {Alida A.} and Groot, {P. F. C.} and {MR CLEAN Investigators}",

note = "Funding Information: The MR CLEAN Registry was partly funded by TWIN Foundation, Erasmus MC University Medical Center, Maastricht University Medical Center and Academic Medical Center Amsterdam. Erasmus MC received funds from Stryker{\textcopyright}R by DD, AvdL, and Bracco Imaging{\textcopyright}R by DD. MUMC received funds from Stryker{\textcopyright}R and Codman{\textcopyright}R for consultations by WZ. The MR CLEAN trial was partly funded by the Dutch Heart Foundation and by unrestricted grants from AngioCare BV, Medtronic/Covidien/EV3{\textcopyright}R, MEDAC GmbH/LAMEPRO, Penumbra Inc., Stryker{\textcopyright}R , and Top Medical/Concentric. Publisher Copyright: Copyright {\textcopyright} 2019 Compagne, Goldhoorn, Uyttenboogaart, van Oostenbrugge, van Zwam, van Doormaal, Dippel, van der Lugt, Emmer, van Es and the MR CLEAN investigators. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.",

year = "2019",

month = feb,

day = "19",

doi = "10.3389/fneur.2019.00102",

language = "English",

volume = "10",

pages = "1--9",

journal = "Frontiers in Neurology",

issn = "1664-2295",

publisher = "Frontiers Media SA",

}

Compagne, KCJ, Goldhoorn, RB, Uyttenboogaart, M, van Oostenbrugge, RJ , van Zwam, WH, van Doormaal, PJ, Dippel, DWJ, van der Lugt, A, Emmer, BJ, van Es, ACGM, Majoie, CBLM, Roos, YBWEM, Boiten, J, Vos, JA, Jansen, IGH, Mulder, MJHL, Kappelhof, M, Schonewille, WJ, Coutinho, JM, Wermer, MJH, van Walderveen, MAA, Staals, J, Hofmeijer, J, Martens, JM, Nijeholt, GJL, Roozenbeek, B, de Bruijn, SF, van Dijk, LC, van der Worp, HB, Lo, RH, van Dijk, EJ, Boogaarts, HD, de Kort, PLM, Peluso, JJP, van den Berg, JSP, van Hasselt, BAAM, Aerden, LAM, Dallinga, RJ, Eshghi, O, Schreuder, THCML, Heijboer, RJJ, Keizer, K, Yo, LSF, den Hertog, HM, Sturm, EJC, Sprengers, MES, Jenniskens, SFM, van den Berg, R, Postma, AA, Groot, PFC & MR CLEAN Investigators 2019, 'Acute Endovascular Treatment of Patients With lschemic Stroke From Intracranial Large Vessel Occlusion and Extracranial Carotid Dissection', Frontiers in Neurology, vol. 10, 102, pp. 1-9. https://doi.org/10.3389/fneur.2019.00102

TY - JOUR

T1 - Acute Endovascular Treatment of Patients With lschemic Stroke From Intracranial Large Vessel Occlusion and Extracranial Carotid Dissection

AU - Compagne, Kars C. J.

AU - Goldhoorn, R. B.

AU - Uyttenboogaart, Maarten

AU - van Oostenbrugge, Robert J.

AU - van Zwam, Wim H.

AU - van Doormaal, Pieter J.

AU - Dippel, Diederik W. J.

AU - van der Lugt, Aad

AU - Emmer, Bart J.

AU - van Es, Adriaan C. G. M.

AU - Majoie, Charles B. L. M.

AU - Roos, Yvo B. W. E. M.

AU - Boiten, Jelis

AU - Vos, Jan Albert

AU - Jansen, Ivo G. H.

AU - Mulder, Maxim J. H. L.

AU - Kappelhof, Manon

AU - Schonewille, Wouter J.

AU - Coutinho, Jonathan M.

AU - Wermer, Marieke J. H.

AU - van Walderveen, Marianne A. A.

AU - Staals, Julie

AU - Hofmeijer, Jeannette

AU - Martens, Jasper M.

AU - Nijeholt, Geert J. Lycklama

AU - Roozenbeek, Bob

AU - de Bruijn, Sebastiaan F.

AU - van Dijk, Lukas C.

AU - van der Worp, H. Bart

AU - Lo, Rob H.

AU - van Dijk, Ewoud J.

AU - Boogaarts, Hieronymus D.

AU - de Kort, Paul L. M.

AU - Peluso, Jo J. P.

AU - van den Berg, Jan S. P.

AU - van Hasselt, Boudewijn A. A. M.

AU - Aerden, Leo A. M.

AU - Dallinga, Ren J.

AU - Eshghi, Omid

AU - Schreuder, Tobien H. C. M. L.

AU - Heijboer, Roel J. J.

AU - Keizer, Koos

AU - Yo, Lonneke S. F.

AU - den Hertog, Heleen M.

AU - Sturm, Emiel J. C.

AU - Sprengers, Marieke E. S.

AU - Jenniskens, Sjoerd F. M.

AU - van den Berg, Rene

AU - Postma, Alida A.

AU - Groot, P. F. C.

AU - MR CLEAN Investigators

N1 - Funding Information: The MR CLEAN Registry was partly funded by TWIN Foundation, Erasmus MC University Medical Center, Maastricht University Medical Center and Academic Medical Center Amsterdam. Erasmus MC received funds from Stryker©R by DD, AvdL, and Bracco Imaging©R by DD. MUMC received funds from Stryker©R and Codman©R for consultations by WZ. The MR CLEAN trial was partly funded by the Dutch Heart Foundation and by unrestricted grants from AngioCare BV, Medtronic/Covidien/EV3©R, MEDAC GmbH/LAMEPRO, Penumbra Inc., Stryker©R , and Top Medical/Concentric. Publisher Copyright: Copyright © 2019 Compagne, Goldhoorn, Uyttenboogaart, van Oostenbrugge, van Zwam, van Doormaal, Dippel, van der Lugt, Emmer, van Es and the MR CLEAN investigators. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

PY - 2019/2/19

Y1 - 2019/2/19

N2 - Introduction: Carotid artery dissection (CAD) and atherosclerotic carotid artery occlusion (ACAO) are major causes of a tandem occlusion in patients with intracranial large vessel occlusion (LVO). Presence of tandem occlusions may hamper intracranial access and potentially increases the risk of procedural complications of endovascular treatment (EVT). Our aim was to assess neurological, functional and technical outcome and complications of EVT for intracranial LVO in patients with CAD in comparison to patients with ACAO and to patients without CAD or ACAO. Methods: We analyzed data of the MR CLEAN trial intervention arm and MR CLEAN Registry, acquired in 16 Dutch EVT-centers. Primary outcome was the change in stroke severity by comparing the National Institute of Health Stroke Scale (NIHSS) score at 24–48 h after treatment vs. baseline. Secondary outcomes included reperfusion rate and symptomatic intracranial hemorrhage (sICH). We compared outcomes and complications between patients with CAD vs. patients with ACAO and patients without CAD or ACAO. Results: In total, we identified 74 (4.7%) patients with CAD, 92 (5.9%) patients with ACAO and 1398 (89.4%) patients without CAD or ACAO. Neurological improvement at short-term after EVT in patients with CAD was significantly better compared to ACAO (resp. mean −5 vs. mean −1 NIHSS point; p = 0.03) and did not differ compared to patients without CAD or ACAO (−4 NIHSS points; p = 0.62). Rates of successful reperfusion in patients with CAD (47%) was comparable to patients with ACAO (47%; p = 1.00), but was less often achieved compared to patients without CAD or ACAO (58%; p = 0.08). Occurrence of sICH did not differ significantly between CAD patients (5%) and ACAO (11%; p = 0.33) or without CAD/ACAO (6%; p = 1.00). Conclusion: EVT in patients with intracranial LVO due to CAD results in neurological improvement comparable to patients without tandem occlusions. Therefore, carotid artery dissection by itself should not be a contraindication for endovascular treatment in stroke patients with intracranial large vessel occlusion. Although more challenging endovascular procedures are to be suspected in both patients with CAD or ACAO, accurate distinction between CAD and ACAO might influence clinical decision making as better clinical outcome can be expected in patients with CAD.

AB - Introduction: Carotid artery dissection (CAD) and atherosclerotic carotid artery occlusion (ACAO) are major causes of a tandem occlusion in patients with intracranial large vessel occlusion (LVO). Presence of tandem occlusions may hamper intracranial access and potentially increases the risk of procedural complications of endovascular treatment (EVT). Our aim was to assess neurological, functional and technical outcome and complications of EVT for intracranial LVO in patients with CAD in comparison to patients with ACAO and to patients without CAD or ACAO. Methods: We analyzed data of the MR CLEAN trial intervention arm and MR CLEAN Registry, acquired in 16 Dutch EVT-centers. Primary outcome was the change in stroke severity by comparing the National Institute of Health Stroke Scale (NIHSS) score at 24–48 h after treatment vs. baseline. Secondary outcomes included reperfusion rate and symptomatic intracranial hemorrhage (sICH). We compared outcomes and complications between patients with CAD vs. patients with ACAO and patients without CAD or ACAO. Results: In total, we identified 74 (4.7%) patients with CAD, 92 (5.9%) patients with ACAO and 1398 (89.4%) patients without CAD or ACAO. Neurological improvement at short-term after EVT in patients with CAD was significantly better compared to ACAO (resp. mean −5 vs. mean −1 NIHSS point; p = 0.03) and did not differ compared to patients without CAD or ACAO (−4 NIHSS points; p = 0.62). Rates of successful reperfusion in patients with CAD (47%) was comparable to patients with ACAO (47%; p = 1.00), but was less often achieved compared to patients without CAD or ACAO (58%; p = 0.08). Occurrence of sICH did not differ significantly between CAD patients (5%) and ACAO (11%; p = 0.33) or without CAD/ACAO (6%; p = 1.00). Conclusion: EVT in patients with intracranial LVO due to CAD results in neurological improvement comparable to patients without tandem occlusions. Therefore, carotid artery dissection by itself should not be a contraindication for endovascular treatment in stroke patients with intracranial large vessel occlusion. Although more challenging endovascular procedures are to be suspected in both patients with CAD or ACAO, accurate distinction between CAD and ACAO might influence clinical decision making as better clinical outcome can be expected in patients with CAD.

KW - ischemic stroke

KW - carotid dissection

KW - endovascular treatment

KW - tandem lesion

KW - thrombectomy

KW - ACUTE ISCHEMIC-STROKE

KW - ARTERY DISSECTION

KW - MECHANICAL THROMBECTOMY

KW - INTRAARTERIAL TREATMENT

KW - MANAGEMENT

KW - REPERFUSION

KW - SCORE

U2 - 10.3389/fneur.2019.00102

DO - 10.3389/fneur.2019.00102

M3 - Article

C2 - 30837934

SN - 1664-2295

VL - 10

SP - 1

EP - 9

JO - Frontiers in Neurology

JF - Frontiers in Neurology

M1 - 102

ER -

Acute Endovascular Treatment of Patients With lschemic Stroke From Intracranial Large Vessel Occlusion and Extracranial Carotid Dissection

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Keywords

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