Transcarotid Access for Mechanical Thrombectomy in Acute Ischemic Stroke: A Meta-Analysis and Systematic Review

Authors

• Allison J. Zhong, New York Medical College School of Medicine, Valhalla, NY, USA.
• Haris Kamal, Department of Neurosurgery, Westchester Medical Center at New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA.
• Anaz Uddin, New York Medical College School of Medicine, Valhalla, NY, USA.
• Eric Feldstein, Department of Neurosurgery, Westchester Medical Center at New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA.
• Steven D. Shapiro, Department of Neurosurgery, Westchester Medical Center at New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA; Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY, USA.
• Joon Yong Chung, New York Medical College School of Medicine, Valhalla, NY, USA.
• Maziyah Ogarro, New York Medical College School of Medicine, Valhalla, NY, USA.
• Rebecca Friedman, New York Medical College School of Medicine, Valhalla, NY, USA.
• Josh Simmons, New York Medical College School of Medicine, Valhalla, NY, USA.
• Gillian Graifman, New York Medical College School of Medicine, Valhalla, NY, USA.
• Christeena Kurian, Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY, USA.
• Gurmeen Kaur, Department of Neurosurgery, Westchester Medical Center at New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA; Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY, USA.
• Stephan A. Mayer, Department of Neurosurgery, Westchester Medical Center at New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA; Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY, USA.Follow
• Ji Chong, Department of Neurosurgery, Westchester Medical Center at New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA; Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY, USA.Follow
• Chirag D. Gandhi, Department of Neurosurgery, Westchester Medical Center at New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA; Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY, USA.Follow
• Fawaz Al-Mufti, Department of Neurosurgery, Westchester Medical Center at New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA; Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY, USA. Electronic address: Fawaz.Al-Mufti@wmchealth.org.Follow

Author Type(s)

Faculty, Resident/Fellow

DOI

10.1016/j.jstrokecerebrovasdis.2022.106428

Journal Title

Journal of Stroke and Cerebrovascular Diseases

First Page

106428

Document Type

Article

Publication Date

5-1-2022

Department

Neurology

Second Department

Neurosurgery

Keywords

Carotid, Cervical, Intervention, Stroke, Technique, Thrombectomy

Disciplines

Medicine and Health Sciences

Abstract

OBJECTIVES: Despite the success of mechanical thrombectomy in large vessel acute ischemic stroke, recanalization may fail due to difficult anatomic access or peripheral arterial occlusive disease. In these cases, transcarotid access may be used as an alternative, but it has not gained prominence due to safety concerns. Our objective was to assess the efficacy and safety of transcarotid access for mechanical thrombectomy. MATERIALS AND METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to perform a systematic review with articles published from 2010 to 2020 summarizing pre-intervention characteristics, techniques utilized, and outcomes of patients undergoing mechanical thrombectomy via trans-carotid puncture. We performed a meta-analysis of clinical outcomes, reperfusion times and overall complications rates of trans-carotid approach. RESULTS: Six studies describing 80 total attempts at carotid access, 72 of which were successful (90% success rate), were included. Direct carotid puncture was most often used as a rescue technique (87% of patients) secondary to failed femoral access. Successful recanalization was achieved in 76% of patients. 90 day modified Rankin Scale ≤ 2 was achieved in 28% of patients. Carotid puncture-reperfusion time was 32 min (CI = 24-40, p < 0.001). Cervical complications occurred at a rate of 26.5% (95% CI = 17%-38%). Only 1.3% (1/80 patients) had a fatal outcome and 96% of complications required no intervention. CONCLUSIONS: Our results on the safety and efficacy of transcarotid access suggests that this approach is a viable alternative to failed thrombectomy when transfemoral or trans-radial access may be impractical.

Recommended Citation

Zhong, A. J., Kamal, H., Uddin, A., Feldstein, E., Shapiro, S. D., Chung, J. Y., Ogarro, M., Friedman, R., Simmons, J., Graifman, G., Kurian, C., Kaur, G., Mayer, S. A., Chong, J., Gandhi, C. D., & Al-Mufti, F. (2022). Transcarotid Access for Mechanical Thrombectomy in Acute Ischemic Stroke: A Meta-Analysis and Systematic Review. Journal of Stroke and Cerebrovascular Diseases, 31 (5), 106428. https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106428