Safety of acute internal carotid artery stenting during endovascular thrombectomy in patients with acute ischemic stroke: a retrospective analysis of the OPTIMISE registry

George Nilton Mendes; Grégory Jacquin; Aristeidis H Katsanos; Nishita Singh; Grant Stotts; Darren B Ferguson; Samuel Yip; Alexandre Y Poppe

doi:10.1136/jnis-2024-021915

Safety of acute internal carotid artery stenting during endovascular thrombectomy in patients with acute ischemic stroke: a retrospective analysis of the OPTIMISE registry

J Neurointerv Surg. 2024 Jun 27:jnis-2024-021915. doi: 10.1136/jnis-2024-021915. Online ahead of print.

Authors

George Nilton Mendes^#^{1

2}, Grégory Jacquin^#^{1

2}, Aristeidis H Katsanos³, Nishita Singh⁴, Grant Stotts^{5

6}, Darren B Ferguson⁷, Samuel Yip⁸, Alexandre Y Poppe^{9

2}

Affiliations

¹ Neurosciences Axis, Centre de Recherche du CHUM, Montreal, Quebec, Canada.
² Neurosciences, Centre Hospitalier de L'Universite de Montreal, Montreal, Quebec, Canada.
³ Medicine (Neurology), McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.
⁴ Internal Medicine (Neurology), University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada.
⁵ Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁶ Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
⁷ Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada.
⁸ Medicine (Neurology), The University of British Columbia, Vancouver, British Columbia, Canada.
⁹ Neurosciences Axis, Centre de Recherche du CHUM, Montreal, Quebec, Canada [email protected].

^# Contributed equally.

PMID: 38937083
DOI: 10.1136/jnis-2024-021915

Abstract

Background: The optimal management of tandem carotid lesions during endovascular thrombectomy (EVT) remains uncertain. The safety and efficacy of acute carotid artery stenting (aCAS) are debated, including safety concerns such as procedural complications and symptomatic intracerebral hemorrhage (sICH). We aimed to assess aCAS safety among EVT-treated patients using a large Canadian registry.

Methods: We retrospectively analyzed the OPTIMISE registry and compared adult patients undergoing EVT and aCAS versus EVT only. The primary outcome was a composite of in-hospital death, long-term care facility destination at discharge, sICH, or any EVT-related procedural complications. Secondary outcomes included individual components of the primary outcome, EVT workflow times, final modified Thrombolysis in Cerebral Ischemia score and 90-day modified Rankin Scale score. Statistical significance was evaluated by a multivariate logistic regression model.

Results: 4205 patients were included (330 with EVT-aCAS and 3875 with EVT-only). Both groups were similar with regard to baseline National Institutes of Health Stroke Scale score, Alberta Stroke Program Early CT Score and use of IV thrombolysis, but differed in age (EVT-aCAS group 67.2±12.1 years vs EVT-only group 71.3±14.1 years, P<0.001), proportion of women (28.2% vs 53.3%, P<0.001), and occlusion location (internal carotid artery terminus 44% vs 16%, P<0.001). The EVT-aCAS group showed a non-significant increase in odds of composite safety outcomes (adjusted OR 1.35 (95% CI 0.97 to 1.84), P=0.06) with a significantly higher proportion of procedural complications (10.0% vs 6.2%, P=0.002).

Conclusion: In a large national registry, EVT-aCAS was associated with a higher proportion of unfavorable safety outcomes, driven by more frequent procedural complications. Further research is needed to clarify the role of aCAS in tandem occlusion stroke.

Keywords: Stenosis; Stent; Stroke; Thrombectomy.