Article Dans Une Revue Journal of Neurointerventional Surgery Année : 2022

Carotid artery direct access for mechanical thrombectomy: the Carotid Artery Puncture Evaluation (CARE) study

1 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
2 UNIBE - Universität Bern = University of Bern = Université de Berne
3 Inselspital - Bern University Hospital [Berne]
4 Service de Neuroradiologie [Brest]
5 CHU Limoges
6 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
7 IGF - Institut de Génomique Fonctionnelle
8 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
9 UMG - University Medical Center Göttingen
10 CHU Pitié-Salpêtrière [AP-HP]
11 CHU Clermont-Ferrand
12 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
13 IPNP - U1266 Inserm - Institut de psychiatrie et neurosciences de Paris
14 CHCB - Centre Hospitalier de la Côte Basque
15 LTSI - Laboratoire Traitement du Signal et de l'Image
16 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
17 Hôpital Guillaume-et-René-Laennec [CHU Nantes]
18 Service Neuroradiologie Diagnostique et Thérapeutique [CHU Toulouse]
19 ITX-lab - ITX-lab unité de recherche de l'institut du thorax UMR1087 UMR6291
20 CREATIS - Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé
21 MYRIAD - Modeling & analysis for medical imaging and Diagnosis
22 Hôpital Foch [Suresnes]
23 AOUC - Azienda Ospedaliero Universitaria Careggi [Firenze] = Careggi University Hospital [Florence, Italy]
24 Universitätsklinikum Knappschaftskrankenhaus = University Hospital Knappschaftskrankenhaus [Bochum]
25 CHU de Bordeaux Pellegrin [Bordeaux]
26 CHU Bordeaux - Centre Hospitalier Universitaire de Bordeaux
27 Klinikum Bremen-Mitte - Institute of Clinical Pharmacology
28 NKUA - National and Kapodistrian University of Athens
29 CHU Rouen
30 XLIM - XLIM
31 CHU Limoges - Centre Hospitalier Universitaire Dupuytren 1 et 2
Géraud Forestier
Eimad Shotar
Maxime Geismar
  • Fonction : Auteur
Simon Escalard
  • Fonction : Auteur
Lukas Meyer
Donald Lobsien
  • Fonction : Auteur
Nuran Abdullayev
Vanessa Chalumeau
Jean Philippe Neau
  • Fonction : Auteur
Rémy Guillevin
Hanna Styczen
Cédric Fauché
  • Fonction : Auteur

Résumé

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.

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Dates et versions

hal-04591744 , version 1 (29-05-2024)

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Victor Dumas, Johannes Kaesmacher, Julien Ognard, Géraud Forestier, Cyril Dargazanli, et al.. Carotid artery direct access for mechanical thrombectomy: the Carotid Artery Puncture Evaluation (CARE) study. Journal of Neurointerventional Surgery, 2022, 14, pp.1180-1185. ⟨10.1136/neurintsurg-2021-017935⟩. ⟨hal-04591744⟩
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