Experience of stenting of the extracranial part of the internal carotid artery in patients with acute ischemic stroke
https://doi.org/10.17650/1683-3295-2023-25-3-17-23
Abstract
Aim. To present the experience of stenting of the extracranial internal carotid artery (ICA) in case of tandem steno-occlusive carotid lesion in the most acute phase of ischemic stroke.
Materials and methods. From December 2018 to December 2021, 29 patients with acute ischemic stroke, because of tandem steno-occlusive lesions of the ICA and intracranial arteries, underwent endovascular surgery to restore cerebral blood flow.
Results. Successful restoration of cerebral blood flow (according to the mTICI 2b–3 scale) achieved in 22 (75.9 %) patients. Four (13.8 %) patients had stent thrombosis in the early postoperative period. The incidence of symptomatic hemorrhagic transformation observed in 2 (6.9 %) patients. The frequency of a favorable functional outcome (Rankine 0–2) on the 30th day was 20.7 %, mortality – 24.1 %.
Conclusion. Stenting of the extracranial ICA in patients with acute ischemic stroke improves the efficiency of restoration of cerebral blood flow. The use of low doses of glycoprotein receptor blockers prevents stent thrombosis in the early period after implantation and does not increase the incidence of symptomatic hemorrhagic complications.
About the Authors
M. Yu. Volodukhin
IInterregional clinical diagnostic center;
Kazan State Medical Academy – branch of the Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia;
Kazan State Medical University, Ministry of Health of Russia
Russian Federation
Russian Federation
Mikhail Yuryevich Volodukhin
2a Karbysheva St., Kazan 420116;
11 Mushtary St., Kazan 420012;
49 Butlerova St., Kazan 420012
I. A. Podshivalov
IInterregional clinical diagnostic center;
Kazan State Medical University, Ministry of Health of Russia
Russian Federation
Russian Federation
2a Karbysheva St., Kazan 420116;
49 Butlerova St., Kazan 420012
D. R. Khasanova
IInterregional clinical diagnostic center;
Kazan State Medical University, Ministry of Health of Russia
Russian Federation
Russian Federation
2a Karbysheva St., Kazan 420116;
49 Butlerova St., Kazan 420012
R. N. Khairullin
IInterregional clinical diagnostic center
Russian Federation
Russian Federation
2a Karbysheva St., Kazan 420116
References
1. Bukhtoyarov A.Yu., Oganesyan O.A., Lyaskovsky K.O. et al. Endovascular treatment of acute ischemic stroke in tandem occlusion of the internal carotid artery. Endovaskulyarnaya khirurgiya = Endovascular Surgery 2019;6(1):69–75. (In Russ.). DOI: 10.24183/2409-4080-2019-6-1-69-75
2. Logvinenko R.L., Kokov L.S., Arblinsky A.V. Treatment of acute tandem occlusion of arteries of anterior cerebral circulation without emergency stenting. Angiologiya i sosudistaya khirurgiya = Angiology and Vascular Surgery 2021;27(1):53–63. (In Russ.).
3. Shamalov N.A., Khasanova D.R., Stakhovskaya L.V., Voznuk I.A. Reperfusion therapy for ischemic stroke. Clinical Protocol. Moskow, 2019. 80 p. (In Russ.).
4. Kim B., Kim B.M., Bang O.Y. et al. Carotid artery stenting and intracranial thrombectomy for tandem cervical and intracranial artery occlusions. Neurosurgery 2020;86(2):213–20. DOI: 10.1093/neuros/nyz026
5. Dufort G., Chen B.Y., Jacquin G. et al. Acute carotid stenting in patients undergoing thrombectomy: a systematic review and meta-analysis. J Neurointerv Surg 2021;13(2):141–5. DOI: 10.1136/neurintsurg-2020-015817
6. Papanagiotou P., Haussen D.C., Turjman F. et al. Carotid stenting with antithrombotic agents and intracranial thrombectomy leads to the highest recanalization rate in patients with acute stroke with tandem lesions. JACC Cardiovasc Interv 2018;11(13):1290–9. DOI: 10.1016/j.jcin.2018.05.036
7. Pires Coelho A., Lobo M., Gouveia R. et al. Overview of evidence on emergency carotid stenting in patients with acute ischemic stroke due to tandem occlusions: a systematic review and meta-analysis. J Cardiovasc Surg (Torino) 2019;60(6):693–702. DOI: 10.23736/S0021-9509.18.10312-0.
8. Da Ros V., Scaggiante J., Sallustio F. et al. Carotid stenting and mechanical thrombectomy in patients with acute ischemic stroke and tandem occlusions: antithrombotic treatment and functional outcome. AJNR Am J Neuroradiol 2020;41(11):2088–93. DOI: 10.3174/ajnr.A6768
9. Yan Z., Shi Z., Wang Y. et al. Efficacy and safety of low-dose tirofiban for acute intracranial atherosclerotic stenosis related occlusion with residual stenosis after endovascular treatment. J Stroke Cerebrovasc Dis 2020;29(4):104619. DOI: 10.1016/j.jstrokecerebrovasdis.2019.104619
10. Poppe A.Y., Jacquin G., Roy D. et al. Tandem carotid lesions in acute ischemic stroke: mechanisms, therapeutic challenges, and future directions. AJNR Am J Neuroradiol 2020;41(7):1142–8. DOI: 10.3174/ajnr.A6582
11. Steinhubl S.R., Talley J.D., Braden G.A. et al. Point-of-сare measured platelet inhibition correlates with a reduced risk of an adverse cardiac event after percutaneous coronary intervention: results of thr GOLD (AU-Assessing Ultegra) multicenter study. Circulation 2001;103(21):2572–8. DOI: 10.1161/01.CIR.103.21.2572
12. Jost A., Roels C., Brown M. et al. Low-dose eptifibatide for tandem occlusion in stroke: safety and carotid artery patency. AJRN Am J Neuroradiol 2021;42(4):738–42. DOI: 10.3174/ajnr.A6985
13. Pfaff J.A.R., Maurer C., Broussalis E. et al. Acute thromboses and occlusions of dual layer carotid stents in endovascular treatment of tandem occlusions. J Neurointerv Surg 2020;12(1):33–7. DOI: 10.1136/neurintsurg-2019-015032.
14. Bartolini B., Puccinelli F., Mosimann P.J. et al. Evaluating the effectiveness and safety of the carotid Casper-RX stent for tandem lesions in acute ischemic stroke. J Neurointerv Surg 2019;11(8):772–4. DOI: 10.1136/neurintsurg-2018-014425
15. Volodiukhin M.Yu. Сerebral blood flow occlusion when performing thrombectomy in patients with acute ischemic stroke. Aspirantskiy vestnik Povoljya = Aspiran Bulletin of the Volga region 2016;1–2: 172–5. (In Russ.).
Review
For citations:
Volodukhin M.Yu., Podshivalov I.A., Khasanova D.R., Khairullin R.N. Experience of stenting of the extracranial part of the internal carotid artery in patients with acute ischemic stroke. Russian journal of neurosurgery. 2023;25(3):17-23, 152-156. https://doi.org/10.17650/1683-3295-2023-25-3-17-23
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