Background

The optimal approach to treat the cervical carotid artery lesion during endovascular thrombectomy (EVT) for acute strokes with tandem occlusions is unclear. While carotid artery stenting (CAS) might be a more definitive recanalization method, the potential risk of intracranial hemorrhage (ICH) limits its routine usage. In this study, we aimed to evaluate the safety outcomes of CAS and carotid artery angioplasty (CAA) in patients with acute tandem occlusions.

Methods

In this retrospective cohort study, data were obtained from the Nationwide Readmissions Database 2016–2017. The primary safety outcome was a composite of ICH and all-cause in-hospital mortality. Logistic regression analysis was used to compare the in-hospital outcomes. Survival analysis was used to estimate the 30-day readmissions.

Results

We identified 2042 hospitalizations meeting the study inclusion criteria (median age: 66 years, female 31.3%). Of these, 1391 (68.1%) had undergone CAS and 651 (31.9%) CAA alone. Baseline characteristics between the two groups were similar, except patients with CAS were more likely to be on anti-thrombotic medications and were less likely to have received intravenous thrombolysis. There was no significant difference in the clinical outcomes including ICH, in-hospital mortality, gastrostomy tube placement, prolonged mechanical ventilation, length of stay, hospital charges, and 30-day readmissions between the two groups, however, patients with CAS were more likely to be discharged home after adjusting for the confounding variables [odds ratio (OR) 1.49, 95% confidence interval (CI) 1.05–2.12, P 0.025].

Conclusion

The emergent CAS-EVT approach appears to be safe with no adverse outcomes compared to CAA alone.

背景

对于串联闭塞的急性卒中，在血管内血栓切除术 (EVT) 期间治疗颈动脉病变的最佳方法尚不清楚。虽然颈动脉支架置入术 (CAS) 可能是一种更明确的再通方法，但颅内出血 (ICH) 的潜在风险限制了其常规使用。在本研究中，我们旨在评估 CAS 和颈动脉血管成形术 (CAA) 在急性串联闭塞患者中的安全性结果。

方法

在这项回顾性队列研究中，数据来自 2016-2017 年全国再入院数据库。主要安全性结果是 ICH 和全因住院死亡率的复合结果。Logistic回归分析用于比较住院结果。生存分析用于估计 30 天的再入院率。

结果

我们确定了 2042 名符合研究纳入标准的住院患者（中位年龄：66 岁，女性 31.3%）。其中，1391 人 (68.1%) 接受了 CAS，651 人 (31.9%) 单独接受了 CAA。两组之间的基线特征相似，除了 CAS 患者更有可能使用抗血栓药物，并且不太可能接受静脉溶栓。两组的临床结局包括 ICH、院内死亡率、胃造瘘管放置、机械通气时间延长、住院时间、住院费用和 30 天再入院率等方面没有显着差异，但 CAS 患者的可能性更大调整混杂变量后出院回家 [优势比 (OR) 1.49, 95% 置信区间 (CI) 1.05–2.12, P 0.025]。

结论

与单独的 CAA 相比，紧急 CAS-EVT 方法似乎是安全的，没有不良后果。