Dumas, Victor, Kaesmacher, Johannes ORCID: 0000-0002-9177-2289, Ognard, Julien, Forestier, Geraud, Dargazanli, Cyril, Janot, Kevin ORCID: 0000-0002-7305-3125, Behme, Daniel, Shotar, Eimad ORCID: 0000-0002-8712-8431, Chabert, Emmanuel, Velasco, Stephane, Bricout, Nicolas, Ben Hassen, Wagih, Veunac, Louis, Geismar, Maxime, Eugene, Francois, Detraz, Lili, Darcourt, Jean, L'Allinec, Vincent, Eker, Omer F., Consoli, Arturo, Maus, Volker, Gariel, Florent, Marnat, Gaultier, Papanagiotou, Panagiotis, Papagiannaki, Chrisanthi, Escalard, Simon, Meyer, Lukas, Lobsien, Donald, Abdullayev, Nuran, Chalumeau, Vanessa, Neau, Jean Philippe, Guillevin, Remy, Boulouis, Gregoire, Rouchaud, Aymeric, Styczen, Hanna and Fauche, Cedric . Carotid artery direct access for mechanical thrombectomy: the Carotid Artery Puncture Evaluation (CARE) study. J. NeuroInterventional Surg.. LONDON: BMJ PUBLISHING GROUP. ISSN 1759-8486

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Abstract

Background In acute ischemic stroke due to anterior large vessel occlusion (AIS-LVO), accessing the target occluded vessel for mechanical thrombectomy (MT) is sometimes impossible through the femoral approach. We aimed to evaluate the safety and efficacy of direct carotid artery puncture (DCP) for MT in patients with failed alternative vascular access. Methods We retrospectively analyzed data from 45 stroke centers in France, Switzerland and Germany through two research networks from January 2015 to July 2019. We collected physician-centered data on DCP practices and baseline characteristics, procedural variables and clinical outcome after DCP. Uni- and multivariable models were conducted to assess risk factors for complications. Results From January 2015 to July 2019, 28 149 MT were performed, of which 108 (0.39%) resulted in DCP due to unsuccessful vascular access. After DCP, 77 patients (71.3%) had successful reperfusion (modified Thrombolysis In Cerebral Infarction (mTICI) score >= 2b) and 28 (25.9%) were independent (modified Rankin Scale (mRS) score 0-2) at 3 months. 20 complications (18.5%) attributed to DCP occurred, all of them during or within 1 hour of the procedure. Complications led to extension of the intubation time in the intensive care unit in 7 patients (6.4%) and resulted in death in 3 (2.8%). The absence of use of a hemostatic closure device was associated with a higher complication risk (OR 3.04, 95% CI 1.03 to 8.97; p=0043). Conclusion In this large multicentric study, DCP was scantly performed for vascular access to perform MT (0.39%) in patients with AIS-LVO and had a high rate of complications (18.5%). Our results provide arguments for not closing the cervical access by manual compression after MT.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Dumas, VictorUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kaesmacher, JohannesUNSPECIFIEDorcid.org/0000-0002-9177-2289UNSPECIFIED
Ognard, JulienUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Forestier, GeraudUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dargazanli, CyrilUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Janot, KevinUNSPECIFIEDorcid.org/0000-0002-7305-3125UNSPECIFIED
Behme, DanielUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Shotar, EimadUNSPECIFIEDorcid.org/0000-0002-8712-8431UNSPECIFIED
Chabert, EmmanuelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Velasco, StephaneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bricout, NicolasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ben Hassen, WagihUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Veunac, LouisUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Geismar, MaximeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Eugene, FrancoisUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Detraz, LiliUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Darcourt, JeanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
L'Allinec, VincentUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Eker, Omer F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Consoli, ArturoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Maus, VolkerUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gariel, FlorentUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Marnat, GaultierUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Papanagiotou, PanagiotisUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Papagiannaki, ChrisanthiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Escalard, SimonUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Meyer, LukasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lobsien, DonaldUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Abdullayev, NuranUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Chalumeau, VanessaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Neau, Jean PhilippeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Guillevin, RemyUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Boulouis, GregoireUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rouchaud, AymericUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Styczen, HannaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fauche, CedricUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-607649
DOI: 10.1136/neurintsurg-2021-017935
Journal or Publication Title: J. NeuroInterventional Surg.
Publisher: BMJ PUBLISHING GROUP
Place of Publication: LONDON
ISSN: 1759-8486
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
ACUTE ISCHEMIC-STROKE; ENDOVASCULAR TREATMENT; METAANALYSIS; VESSELMultiple languages
Neuroimaging; SurgeryMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/60764

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