title: Emergency Stenting of the Extracranial Internal Carotid Artery in Combination with Anterior Circulation Thrombectomy in Acute Ischemic Stroke: A Retrospective Multicenter Study.
abstract: OBJECTIVE
  Several small case series reported a favorable clinical outcome for emergency stent placement in the extracranial internal carotid artery combined with mechanical thrombectomy in acute stroke. The rate of postinterventional symptomatic intracranial hemorrhages was reported to be as high as 20%. Therefore, we investigated the safety and efficacy of this technique in a large multicentric cohort.
  
  
  METHODS
  The data bases of 4 German stroke centers were screened for all patients who received emergency stent placement of the extracranial internal carotid artery in combination with mechanical thrombectomy of the anterior circulation between 2007 and 2014. The primary outcome measure was the rate of symptomatic intracranial hemorrhage according to the European Cooperative Acute Stroke Study III criteria; secondary outcome measures included the angiographic revascularization results and clinical outcome.
  
  
  RESULTS
  One hundred seventy patients with a median age of 64 years (range, 25-88 years) were treated. They presented after a median of 98 minutes (range, 52-160 minutes) with a median NIHSS score of 15 (range, 12-19). Symptomatic intracranial hemorrhages occurred in 15/170 (9%) patients; there was no statistically significant difference among groups pertaining to age, sex, intravenous rtPA, procedural timings, and the rate of successful recanalization. In 130/170 (77%) patients, a TICI score of ≥ 2b could be achieved. The in-hospital mortality rate was 19%, and 36% of patients had a favorable outcome at follow-up.
  
  
  CONCLUSIONS
  Emergency stent placement in the extracranial internal carotid artery in combination with anterior circulation thrombectomy is effective and safe. It is not associated with a significantly higher risk of symptomatic intracranial hemorrhage compared with published series for mechanical thrombectomy alone.
authors: From the Departments of Neuroradiology (D.B., M.N.P., M.K.) daniel.behme@med.uni-goettingen.de.
authors: D
authors: D
authors: Behme
authors: Department of Radiology and Neuroradiology (A.M., P.Z., C.K., T.L.), University Cologne, University Hospital Cologne, Cologne, Germany.
authors: A
authors: A
authors: Mpotsaris
authors: Department of Radiology and Neuroradiology (A.M., P.Z., C.K., T.L.), University Cologne, University Hospital Cologne, Cologne, Germany.
authors: P
authors: P
authors: Zeyen
authors: From the Departments of Neuroradiology (D.B., M.N.P., M.K.).
authors: M N
authors: MN
authors: Psychogios
authors: Department of Radiology and Neuroradiology (A.K., W.W.), Ruhr-University-Bochum, University Medical Center Langendreer, Bochum, Germany.
authors: A
authors: A
authors: Kowoll
authors: Departments of Radiology and Neuroradiology (C.J.M., A.B.).
authors: C J
authors: CJ
authors: Maurer
authors: Neurology (F.J.), Klinikum Augsburg, Augsburg, Germany.
authors: F
authors: F
authors: Joachimski
authors: Neurology (J.L., K.W.), Georg-August-University Göttingen, University Medical Center, Göttingen, Germany.
authors: J
authors: J
authors: Liman
authors: Neurology (J.L., K.W.), Georg-August-University Göttingen, University Medical Center, Göttingen, Germany.
authors: K
authors: K
authors: Wasser
authors: Department of Radiology and Neuroradiology (A.M., P.Z., C.K., T.L.), University Cologne, University Hospital Cologne, Cologne, Germany.
authors: C
authors: C
authors: Kabbasch
authors: Departments of Radiology and Neuroradiology (C.J.M., A.B.).
authors: A
authors: A
authors: Berlis
authors: From the Departments of Neuroradiology (D.B., M.N.P., M.K.).
authors: M
authors: M
authors: Knauth
authors: Department of Radiology and Neuroradiology (A.M., P.Z., C.K., T.L.), University Cologne, University Hospital Cologne, Cologne, Germany.
authors: T
authors: T
authors: Liebig
authors: Department of Radiology and Neuroradiology (A.K., W.W.), Ruhr-University-Bochum, University Medical Center Langendreer, Bochum, Germany.
authors: W
authors: W
authors: Weber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D020300:Intracranial Hemorrhages / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000000981:diagnostic imaging / Q000601:surgery*; D017131:Thrombectomy / Q000009:adverse effects* / Q000379:methods*; D016896:Treatment Outcome