International Stroke Conference 2025  /  Neuroendovascular Posters I  /  Emergent Carotid Stenting During Thrombectomy in Tandem Occlusions Secondary to Dissection
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American Heart Association

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Final ID: WP237

Emergent Carotid Stenting During Thrombectomy in Tandem Occlusions Secondary to Dissection

Abstract Body: Background:
The optimal endovascular management of cervical carotid dissection causing tandem occlusion remains uncertain. We aimed to investigate the impact of emergent carotid stenting during endovascular treatment (EVT) for acute ischemic stroke (AIS) in patients with tandem occlusion secondary to cervical carotid artery dissection.

Methods:
This was a secondary analysis of patients treated with EVT for AIS due to occlusive carotid artery dissection and tandem occlusion included in the retrospective international Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection (STOP-CAD) study. We compared patients with and without emergent stenting. The primary efficacy and safety outcomes were 90-day functional independence (modified Rankin Scale 0-2) and symptomatic intracranial hemorrhage (sICH) within 24h after EVT, respectively. Technical outcome was successful intracranial recanalization (mTICI 2b/3). We performed a systematic review and meta-analysis, incorporating our results with previously published data.

Results:
Of the 4023 patients enrolled in STOP-CAD, 328 patients presented with anterior circulation AIS due to tandem occlusion and underwent EVT. One hundred fifty patients (150/328, 45.7%) underwent emergent stenting during EVT. There was no statistically significant association between stenting and 90-day functional independence (62.0% vs 59.7%; aOR 1.23, 95% CI 0.82-1.86, p=0.32) or sICH (7.3% vs 7.9%; aOR 0.95, 95% CI 0.41-2.20, p=0.91). Emergent carotid stenting was associated with successful intracranial recanalization (81.8% vs 76.6% aOR 2.62, 95% CI 1.52-4.5, p<0.001). The meta-analysis with a previously published series yielded similar findings.

Conclusion:
In patients presenting with an acute anterior circulation tandem occlusion secondary to cervical carotid artery dissection, emergent stenting was associated with a higher likelihood of successful intracranial recanalization but not with better functional outcomes or increased risk of sICH. Randomized trials are needed to study the efficacy and safety of stenting in this setting.
  • Rodrigo-gisbert, Marc  ( Hospital Universitari Vall d'Hebron , Barcelona , Spain )
  • Sousa, Joao Andre  ( HUC , Coimbra , Portugal )
  • Shu, Liqi  ( Brown University , Providence , Rhode Island , United States )
  • Luo, Anqi  ( Department of Neurology, UT Health San Antonio, San Antonio, Texas, USA , San Antonio , Texas , United States )
  • Mahmoud, Noor  ( University of Oklahoma , Oklahoma city , Oklahoma , United States )
  • Shah, Asghar  ( The Warren Alpert Medical School of Brown University, , Providence , Rhode Island , United States )
  • Oliveira Santos, Ana Luyza  ( University of Oklahoma , Oklahoma city , Oklahoma , United States )
  • Moore, Marina  ( Department of Neurology, University of Texas at Austin - Dell Medical School , Austin , Texas , United States )
  • Mandel, Daniel  ( Brown University , Providence , Rhode Island , United States )
  • Heldner, Mirjam  ( Department of Neurology, Inselspital, University of Bern , Bern , Switzerland )
  • Barata, Vasco  ( HUC , Coimbra , Portugal )
  • Bernardo-castro, Sara  ( HUC , Coimbra , Portugal )
  • Muppa, Jayachandra  ( University of Massachusetts Chan Medical school , Worcester , Massachusetts , United States )
  • Henninger, Nils  ( UMass Chan Medical School , Shrewsbury , Massachusetts , United States )
  • Arnold, Marcel  ( University Hospital Bern , Bern , Switzerland )
  • Nehme, Ahmad  ( Service de Neurologie, Université Caen Normandie, CHU , Caen , France )
  • Rothstein, Aaron  ( University of Pennsylvania , Philadelphia , Pennsylvania , United States )
  • Khazaal, Ossama  ( Temple University Hospital , Philadelphia , Pennsylvania , United States )
  • Kaufmann, Josefin Emelie  ( University Hospital Basel , Basel , Switzerland )
  • Engelter, Stefan  ( University of Basel , Basel , Switzerland )
  • Traenka, Christopher  ( University Hospital Basel , Oberwil , Switzerland )
  • Metanis, Issa  ( hadassah medical center, Hebrew uni , Jerusalem , Israel )
  • Leker, Ronen  ( HEBREW UNIVERSITY-HADASSAH MEDICAL , Jerusalem , Israel )
  • Nolte, Christian  ( Charite Berlin , Berlin , Germany )
  • Ghannam, Malik  ( Department of Neurology, University of Iowa , Iowa city , Iowa , United States )
  • Samaniego, Edgar  ( University of Iowa Hospitals , Iowa City , Iowa , United States )
  • Almajali, Mohammad  ( University of Iowa Hospitals , Iowa City , Iowa , United States )
  • Poppe, Alexandre  ( CHUM , Montreal , Quebec , Canada )
  • Romoli, Michele  ( Department of Neuroscience, Bufalini Hospital , Cesena , Italy )
  • Frontera, Jennifer  ( New York University , Brooklyn , New York , United States )
  • Marialuisa, Zedde  ( Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia , Reggio Emilia , Italy )
  • Kam, Wayneho  ( Department of Neurology, Duke University , Durham , North Carolina , United States )
  • Mac Grory, Brian  ( Department of Neurology, Duke University , Durham , North Carolina , United States )
  • Saleh Velez, Faddi  ( University of oklahoma , Oklahoma , Oklahoma , United States )
  • Ranasinghe, Tamra  ( Department of Neurology, Wake Forest Medical Center , Wake Forest , North Carolina , United States )
  • Siegler, James  ( University of Chicago , Chicago , Illinois , United States )
  • Zubair, Adeel  ( Department of Neurology, Yale New Haven Hospital , New Haven , Connecticut , United States )
  • Marto, Joao Pedro  ( Hospital de Egas Moniz , LISBOA , Portugal )
  • Klein, Piers  ( Department of Neurology, Boston Medical Center , Boston , Massachusetts , United States )
  • Nguyen, Thanh  ( Department of Neurology, Boston Medical Center , Boston , Massachusetts , United States )
  • Abdalkader, Mohamad  ( Department of Neurology, Boston Medical Center , Boston , Massachusetts , United States )
  • Mantovani, Gabriel Paulo  ( Hospital de Clinicas de Porto Alegr , Porto Alegre , Brazil )
  • Simpkins, Alexis  ( Cedars-Sinai Medical Center , Los Angeles , California , United States )
  • Elnazeir, Marwa  ( University of Louisville , Louisville , Kentucky , United States )
  • Yaghi, Shadi  ( Brown University , Providence , Rhode Island , United States )
  • Freitas, Joao  ( HUC , Coimbra , Portugal )
  • Requena, Manuel  ( Vall dHebron Hospital , Barcelona , Spain )
    • Author Disclosures:
    Marc Rodrigo-Gisbert: DO NOT have relevant financial relationships | Mirjam Heldner: DO NOT have relevant financial relationships | Vasco Barata: DO NOT have relevant financial relationships | Sara Bernardo-Castro: DO NOT have relevant financial relationships | Jayachandra Muppa: DO NOT have relevant financial relationships | Nils Henninger: DO NOT have relevant financial relationships | Marcel Arnold: DO have relevant financial relationships ; Advisor:Medtronic:Active (exists now) ; Research Funding (PI or named investigator):Swiss National Science Foundation:Active (exists now) ; Advisor:Novartis:Active (exists now) ; Advisor:Daiichi Sankyo:Active (exists now) ; Advisor:Bohringer Ingelheim:Active (exists now) | Ahmad Nehme: DO NOT have relevant financial relationships | Aaron Rothstein: No Answer | Ossama Khazaal: No Answer | Josefin Emelie Kaufmann: DO have relevant financial relationships ; Researcher:Goldschmidt Jacobson Foundation:Past (completed) | Joao Andre Sousa: DO NOT have relevant financial relationships | Stefan Engelter: DO NOT have relevant financial relationships | Christopher Traenka: DO NOT have relevant financial relationships | Issa Metanis: DO NOT have relevant financial relationships | Ronen Leker: DO NOT have relevant financial relationships | Christian Nolte: DO NOT have relevant financial relationships | Malik Ghannam: No Answer | Edgar Samaniego: DO NOT have relevant financial relationships | Mohammad AlMajali: DO NOT have relevant financial relationships | Alexandre Poppe: DO have relevant financial relationships ; Speaker:Roche Canada:Past (completed) | Michele Romoli: DO NOT have relevant financial relationships | Liqi Shu: DO NOT have relevant financial relationships | Jennifer Frontera: No Answer | Zedde Marialuisa: No Answer | Wayneho Kam: DO NOT have relevant financial relationships | Brian Mac Grory: DO have relevant financial relationships ; Research Funding (PI or named investigator):National Institutes of Health:Active (exists now) ; Research Funding (PI or named investigator):American Heart Association:Active (exists now) | Faddi Saleh Velez: DO NOT have relevant financial relationships | Tamra Ranasinghe: No Answer | James Siegler: DO have relevant financial relationships ; Research Funding (PI or named investigator):Viz.ai:Active (exists now) ; Research Funding (PI or named investigator):NIH:Active (exists now) ; Research Funding (PI or named investigator):Philips:Active (exists now) ; Research Funding (PI or named investigator):Medtronic:Active (exists now) | Adeel Zubair: DO NOT have relevant financial relationships | Joao Pedro Marto: DO NOT have relevant financial relationships | Piers Klein: DO NOT have relevant financial relationships | Anqi Luo: No Answer | Thanh Nguyen: DO have relevant financial relationships ; Other (please indicate in the box next to the company name):American Stroke Association:Active (exists now) ; Advisor:Aruna Bio:Past (completed) ; Advisor:Brainomix:Active (exists now) | Mohamad Abdalkader: DO NOT have relevant financial relationships | Gabriel Paulo Mantovani: DO NOT have relevant financial relationships | Alexis Simpkins: DO have relevant financial relationships ; Research Funding (PI or named investigator):Bristol-Meyers Squibb Foundation:Expected (by end of conference) ; Royalties/Patent Beneficiary:UptoDate:Active (exists now) ; Researcher:NIA/NIH:Active (exists now) | Marwa Elnazeir: No Answer | Shadi Yaghi: DO NOT have relevant financial relationships | JOAO FREITAS: DO NOT have relevant financial relationships | Manuel Requena: DO NOT have relevant financial relationships | Noor Mahmoud: DO NOT have relevant financial relationships | Asghar Shah: DO NOT have relevant financial relationships | Ana Luyza Oliveira Santos: No Answer | Marina Moore: DO NOT have relevant financial relationships | Daniel Mandel: No Answer
Meeting Info:

International Stroke Conference 2025

2025

Los Angeles, CA

Session Info:

Neuroendovascular Posters I

Wednesday, 02/05/2025 , 07:00PM - 07:30PM

Poster Abstract Session

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