Outcomes of Acute Carotid Stenting Studied in Patients With Tandem Lesions Undergoing Thrombectomy

June 12, 2020—A meta-analysis published by Gabrielle Dufort, et al in Journal of NeuroInterventional Surgery (JNIS) suggests that acute carotid stenting is associated with a greater likelihood of a favorable outcome at 90 days compared with no stenting in patients with tandem lesions (TL) undergoing endovascular thrombectomy (EVT).

As summarized in JNIS, the investigators conducted a systematic review and meta-analysis of studies comparing acute carotid stenting versus no stenting among TL patients undergoing EVT with regards to 90-day modified Rankin Scale (mRS) score, symptomatic intracerebral hemorrhage (sICH), and mortality.

Four reviewers screened citations for eligibility and two assessed retained studies for risk of bias and data extraction. A random-effects model was used for the synthesis of aggregated data.

Twenty-one studies (N = 1,635 patients) were identified for the systematic review; 19 were cohort studies, one was a post-hoc analysis of an EVT trial, and one was a pilot randomized controlled trial. The meta-analysis included 16 studies.

In JNIS, the investigators reported the following results:

• Acute stenting was associated with a favorable 90-day mRS score (odds ratio [OR], 1.43; 95% CI, 1.07-1.91)
• No significant heterogeneity between studies was found for this outcome (I² = 17%; χ² = 18.07; P = .26)
• No statistically significant differences for 3-month mortality (OR 0.8; 95% CI, 0.5-1.28) or sICH (OR, 1.41; 95% CI, 0.91-2.19)