O-013 Acute carotid artery stenting versus balloon angioplasty for tandem occlusions: a systematic review and meta-analysis

Abstract

<h3>Background</h3> Despite thrombectomy has become the standard of care for large vessel occlusion strokes, acute endovascular management in tandem occlusions (TO), specially of the cervical internal carotid artery (ICA) lesion, remains uncertain. It widely varies according to clinical and technical considerations and proceduralist’s preference. Revascularization procedures include carotid artery stenting (CAS) ± balloon angioplasty (BA), used as a definitive treatment strategy, performed prior to or following intracranial MT; and acute BA alone, suction aspiration, or MT alone which implicate a deferred treatment with endarterectomy or stenting in the following days or weeks. Each treatment carries potential risks that are taken into consideration when selecting the best treatment method. Recent studies suggest a benefit in functional outcomes and reperfusion rates when CAS and MT are performed emergently, without increasing symptomatic intracranial hemorrhage (sICH) risk. However, all the above-mentioned approaches are used in clinical practice. <h3>Objectives</h3> Compare efficacy and safety of acute CAS to BA alone on treating the cervical ICA lesion in TO through an aggregated data meta-analysis of the recent literature. Similarly, explore those outcomes’ associations with technique approaches and use of thrombolysis. <h3>Methods</h3> We performed a systematic review and meta-analysis to compare functional outcomes (modified Rankin scale [mRS] 0-2 at 3 months), reperfusion, and sICH and 3-month mortality. We explored the association of first approach (anterograde/retrograde) and use of thrombolysis with those outcomes as well. Two independent reviewers performed the screening, data extraction, and quality assessment. A random effects model was used for analysis. <h3>Results</h3> 34 studies including 3014 patients with TO (2482 CAS and 245 BA) were included in our systematic review; and nine, in the meta-analysis. Acute CAS was associated with higher odds of mRS≤2 (OR 1.95 (95% CI 1.24, 3.05) and successful reperfusion (OR 1.89 (95% CI 1.26, 2.83)) with no differences in mortality or sICH rates. Moreover, retrograde approach was significantly associated with mRS≤2 (OR 1.72 (95% CI 1.05, 2.83)) and successful reperfusion (OR 3.18 (95% CI 1.50, 6.74)). No differences were found regarding thrombolysis status. <h3>Conclusions</h3> CAS and retrograde approach had higher odds of successful reperfusion and good functional outcomes at 3 months than BA and anterograde approach, respectively, in TO patients. However, there is still insufficient data regarding antithrombotic therapy and stent patency that might influence the evaluated outcomes. A randomized controlled trial comparing these techniques with structured antithrombotic regimens and safety outcomes will offer definitive guidance in the optimal management of this complex disease. <h3>Disclosures</h3> <b>C. Zevallos:</b> None. <b>M. Farooqui:</b> None. <b>D. Quispe-Orozco:</b> None. <b>A. Mendez-Ruiz:</b> None. <b>A. Dajles:</b> None. <b>A. Garg:</b> None. <b>M. Patterson:</b> None. <b>O. Zaidat:</b> 2; C; Cerenovus, Stryker, Penumbra, Medtronic. <b>S. Ortega-Gutierrez:</b> 2; C; Medtronic, Stryker.