• World Neurosurg · Jul 2023

    Management of Cervical Internal Carotid Artery Stenosis or Occlusion in Tandem Lesion With Acute Ischemic Stroke: Which is More Appropriate Percutaneous Transluminal Angioplasty or Stent?

    • Takeo Kojima, Masanori Aihara, Isao Naito, Tatsuya Shimizu, Naoko Miyamoto, Rei Yamaguchi, Kaoru Aishima, Koji Sato, Hiroya Shimauchi-Ohtaki, Ryosuke Shintoku, Kazuki Wakabayashi, and Yuhei Yoshimoto.
    • Department of Neurosurgery, Saku Central Hospital Nagano Prefectural Federation of Agricultural Cooperation for Health and Welfare, Saku, Nagano, Japan.
    • World Neurosurg. 2023 Jul 1; 175: e208e217e208-e217.

    ObjectiveCarotid artery stenting (CAS) is the established treatment strategy of the cervical internal carotid artery (cICA) stenosis, but its use for acute tandem lesions remains controversial. We investigated the clinical and procedural outcomes of management of cICA lesions and evaluated the risk factors for complications.MethodsFifty patients who underwent acute mechanical thrombectomy for tandem lesion between January 2014 and June 2022 were included. Treatment of the cICA lesion was classified into the CAS group or the non-CAS group. The risk factors for postoperative ischemic events or symptomatic intracranial hemorrhage (sICH) were analyzed.ResultsThe CAS group included 36 patients (72%) and the non-CAS group 14 (28%). Postoperative complications were observed in 9 patients (18%). Thromboembolic complications occurred in 4 patients (29%) of the non-CAS group but in 1 patient (3%) of the CAS group. Severe calcification of the cICA (P = 0.04), non-CAS (P = 0.018), and more than 60% residual stenosis (P = 0.016) were significant risk factors associated with thromboembolic complications. sICH occurred in 4 patients (11%) of the CAS group but in none of the non-CAS group. More than 80% stenosis improvement was significantly associated with sICH (P = 0.049). Twenty-nine patients (58%) had a good clinical outcome at 90 days after onset.ConclusionsAcute CAS is effective for the management for cICA tandem lesions during mechanical thrombectomy, but care not to overextend may be important to reduce the risk of sICH. Severe calcification of the cICA may increase the risk of postoperative thromboembolic complications using non-CAS treatment.Copyright © 2023 Elsevier Inc. All rights reserved.

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