Mechanical Thrombectomy in Cervical Artery Dissection-Related Stroke

Francesco Favruzzo; Ludovica De Rosa; Alvise Fattorello Salimbeni; Stefano Mozzetta; Alessio Pieroni; Federica Viaro; Giacomo Cester; Joseph-Domenico Gabrieli; Francesco Causin; Renzo Manara; Claudio Baracchini

doi:10.1016/j.wneu.2023.06.119

Mechanical Thrombectomy in Cervical Artery Dissection-Related Stroke

World Neurosurg. 2023 Jun 30:S1878-8750(23)00898-7. doi: 10.1016/j.wneu.2023.06.119. Online ahead of print.

Affiliations

¹ Stroke Center, Padua University Hospital, Padua, Italy. Electronic address: francesco.favruzzo@aopd.veneto.it.
² Stroke Center, Padua University Hospital, Padua, Italy.
³ Institute of Neuroradiology, Padua University Hospital, Padua, Italy.

PMID: 37393999
DOI: 10.1016/j.wneu.2023.06.119

Abstract

Background: Cervical artery dissection (CeAD) causing a large vessel occlusion (LVO) stroke might represent a procedural challenge for mechanical thrombectomy (MT) impacting on its effects. The aim of the present study was to analyze safety, reperfusion rates, and clinical outcome of patients with CeAD treated by MT and compare these results with those obtained in non-CeAD patients.

Methods: All consecutive LVO stroke patients undergoing MT between June 2015 and June 2021 at our University Stroke Center were analyzed. Baseline and procedural characteristics, recanalization rates, adverse events, and functional outcome of patients with CeAD were compared with non-CeAD patients.

Results: MT was performed on 375 patients, 20 (5.3%) were diagnosed with CeAD. These patients were younger (52.9 ± 7.8 vs. 72.5 ± 12.9 years, P < 0.001), and showed lower rates of cardiovascular risk factors. In patients with CeAD, tandem occlusions were more frequent (65.0% vs. 14.4%, P < 0.001), groin to reperfusion time was longer (93.6 ± 34.9 vs. 68.3 ± 50.2 minutes, P = 0.01), and general anesthesia was more frequently utilized (70.0% vs. 27.9%, P < 0.001). Recanalization rates (Treatment in Cerebral Infarction 2b-3: 100.0% vs. 88.5%) and MT-related adverse events (10.0% vs. 10.7%) did not differ between the groups, while functional outcome was better in patients with CeAD (modified Rankin Scale 0-2 at 3 months: 85.0% vs. 62.0%, P = 0.038).

Conclusions: Although CeAD represents a procedural challenge, MT constitutes a safe and effective treatment for patients with CeAD with LVO stroke.

Keywords: Acute stroke; Endovascular procedures; Internal carotid artery; Spontaneous dissection; Thrombectomy; Vertebral artery.