Mechanical Thrombectomy in Cervical Artery Dissection-Related Stroke

Abstract

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 CeAD patients treated by MT and compare these results with those obtained in non-CeAD patients. 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 CeAD patients were compared with non-CeAD patients. 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 CeAD patients, 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 (TICI 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 CeAD patients (mRS 0-2 at 3 months: 85.0% vs 62.0%, p=0.038). Although CeAD represents a procedural challenge, MT constitutes a safe and effective treatment for CeAD patients with LVO stroke.