Carotid artery direct access for mechanical thrombectomy: the Carotid Artery Puncture Evaluation (CARE) study. (16th December 2021)

• Record Type: Journal Article
• Authors: Dumas, Victor; Kaesmacher, Johannes; Ognard, Julien; Forestier, Géraud; Dargazanli, Cyril; Janot, Kevin; Behme, Daniel; Shotar, Eimad; Chabert, Emmanuel; Velasco, Stéphane; 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, Rémy; Boulouis, Gregoire; Rouchaud, Aymeric; Styczen, Hanna; Fauché, Cédric;
• Other Names: author non-byline.; Cyril Chivot author non-byline.; Riyad Hanafi author non-byline.; Jean-Baptiste Girot author non-byline.; Anne Pasco Papon author non-byline.; Emeline Berthier author non-byline.; David Higue author non-byline.; Hélène Cailliez author non-byline.; Laurent Lagoarde author non-byline.; Jan Gralla author non-byline.; Pasquale Mordasini author non-byline.; Eike Piechowiak author non-byline.; Tomas Dobrocky author non-byline.; Urs Fischer author non-byline.; Marcel Arnold author non-byline.; Guillaume Charbonnier author non-byline.; Alexandra Biondi author non-byline.; Fortunato Di Caterino author non-byline.; Panagiotis Primikiris author non-byline.; Giovanni Vitale author non-byline.; Louise Bonnet author non-byline.; Sebastian Fischer author non-byline.; Jerôme Berge author non-byline.; Xavier Barreau author non-byline.; Patrice Menegon author non-byline.; Thomas Tourdias author non-byline.; Igor Sibon author non-byline.; Jean-Christophe Gentric author non-byline.; Maria Alexandrou author non-byline.; Charlotte Barbier author non-byline.; Marion Boulanger author non-byline.; Julien Cogez author non-byline.; Sophie Guettier author non-byline.; Romain Schneckenburger author non-byline.; Emmanuel Touze author non-byline.; Louis Boyer author non-byline.; Béatrice Claise author non-byline.; Ricardo Moreno author non-byline.; Abderrahim Zerroug author non-byline.; Federico Bolognini author non-byline.; Ariel Lebedinsky Pablo author non-byline.; Mariette Delaitre author non-byline.; Mariano Musacchio author non-byline.; Christoph Kabbasch author non-byline.; Adrien Villain author non-byline.; Titien Tuilier author non-byline.; Erwah Kalsoum author non-byline.; Aurelien Pacini author non-byline.; Chawkat Ramadane author non-byline.; Olivier Comby Pierre author non-byline.; Pierre Thouant author non-byline.; Frédéric Ricolfi author non-byline.; Joachim Klisch author non-byline.; Christin Clajus author non-byline.; Alexander Radbruch author non-byline.; Amélie Hesse author non-byline.; Jan Liman author non-byline.; Ilko Maier author non-byline.; Jens Fiehler author non-byline.; Jildaz Caroff author non-byline.; Laurent Spelle author non-byline.; Christian Denier author non-byline.; Olivier Chassin author non-byline.; Laura Venditti author non-byline.; Thomas Personnic author non-byline.; Jean-Christophe Ferre author non-byline.; Jean-Yves Gauvrit author non-byline.; Sophie Lagnier-Lemercier author non-byline.; Maria Lassale author non-byline.; Hélène Raoult author non-byline.; Thomas Ronziere author non-byline.; Clément Tracol author non-byline.; Stéphane Vannier author non-byline.; Julien Le Moal author non-byline.; Marc Bintner author non-byline.; Jean-Brice Veyrieres author non-byline.; Pascale Gauthier author non-byline.; Raoul Pop author non-byline.; Remy Beaujeux author non-byline.; Anca Hasiu author non-byline.; Monica Manisor author non-byline.; Dank Mihoc author non-byline.; Stéphane Remer author non-byline.; Bertrand Lapergue author non-byline.; Oghuzan Coskun author non-byline.; Frederico Di Maria author non-byline.; Georges Rodesch author non-byline.; Adrien Wang author non-byline.; David Weisenburger-Lile author non-byline.; Sergio Zimatore author non-byline.; Nadia Ajili author non-byline.; Géraldine Buard author non-byline.; Serge Evrard author non-byline.; Lucas Gorza author non-byline.; Julie Gratieux author non-byline.; Morgan Leguen author non-byline.; Sylvie Marinier author non-byline.; Fernando Pico author non-byline.; Roxanna Poll author non-byline.; Haja Rakotoharinandrasana author non-byline.; Philippe Tassan author non-byline.; Maya Tchikviladze author non-byline.; Charles Arteaga author non-byline.; Elie Lteif author non-byline.; Christophe Cognard author non-byline.; Christine Januel Anne author non-byline.; Fabrice Bonneville author non-byline.; Philippe Tall author non-byline.; Pierre Guedin author non-byline.; Hocine Redjem author non-byline.; Denis Herbreteau author non-byline.; Richard Bibi author non-byline.; Fakhreddine Boustia author non-byline.; Igorle Maldonado author non-byline.; Anthony Bras author non-byline.;
• Is Part Of: Journal of neurointerventional surgery. Volume 14:Number 12(2022)
• Page Start: 1180
• Page End: 1185
• Publication Date: 2021-12-16
• Subjects: thrombectomy -- stroke -- artery -- complication; Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2021-017935
• Languages: English
• ISSNs: 1759-8478

Abstract

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.