Carotid artery direct access for mechanical thrombectomy: the Carotid Artery Puncture Evaluation (CARE) study
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Carotid artery direct access for mechanical thrombectomy: the Carotid Artery Puncture Evaluation (CARE) study. / 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; JENI, SFNR and the YOUNICORN Research collaborations.
In: J NEUROINTERV SURG, Vol. 14, No. 12, 12.2022, p. 1180-1185.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Carotid artery direct access for mechanical thrombectomy: the Carotid Artery Puncture Evaluation (CARE) study
AU - Dumas, Victor
AU - Kaesmacher, Johannes
AU - Ognard, Julien
AU - Forestier, Géraud
AU - Dargazanli, Cyril
AU - Janot, Kevin
AU - Behme, Daniel
AU - Shotar, Eimad
AU - Chabert, Emmanuel
AU - Velasco, Stéphane
AU - Bricout, Nicolas
AU - Ben Hassen, Wagih
AU - Veunac, Louis
AU - Geismar, Maxime
AU - Eugene, Francois
AU - Detraz, Lili
AU - Darcourt, Jean
AU - L'Allinec, Vincent
AU - Eker, Omer F
AU - Consoli, Arturo
AU - Maus, Volker
AU - Gariel, Florent
AU - Marnat, Gaultier
AU - Papanagiotou, Panagiotis
AU - Papagiannaki, Chrisanthi
AU - Escalard, Simon
AU - Meyer, Lukas
AU - Lobsien, Donald
AU - Abdullayev, Nuran
AU - Chalumeau, Vanessa
AU - Neau, Jean Philippe
AU - Guillevin, Rémy
AU - Boulouis, Gregoire
AU - Rouchaud, Aymeric
AU - Styczen, Hanna
AU - Fauché, Cédric
AU - JENI, SFNR and the YOUNICORN Research collaborations
N1 - © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2022/12
Y1 - 2022/12
N2 - 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.
AB - 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.
U2 - 10.1136/neurintsurg-2021-017935
DO - 10.1136/neurintsurg-2021-017935
M3 - SCORING: Journal article
C2 - 34916267
VL - 14
SP - 1180
EP - 1185
JO - J NEUROINTERV SURG
JF - J NEUROINTERV SURG
SN - 1759-8478
IS - 12
ER -
