Carotid artery direct access for mechanical thrombectomy: the Carotid Artery Puncture Evaluation (CARE) study.

BACKGROUND In acute ischemic stroke due to anterior large vessel occlusion (AIS-LVO), accessing the target occluded vessel for mechanical thrombectomy (MT) is sometimes impossible through the femoral approach. We aimed to evaluate the safety and efficacy of direct carotid artery puncture (DCP) for MT in patients with failed alternative vascular access. METHODS We retrospectively analyzed data from 45 stroke centers in France, Switzerland and Germany through two research networks from January 2015 to July 2019. We collected physician-centered data on DCP practices and baseline characteristics, procedural variables and clinical outcome after DCP. Uni- and multivariable models were conducted to assess risk factors for complications. RESULTS From January 2015 to July 2019, 28 149 MT were performed, of which 108 (0.39%) resulted in DCP due to unsuccessful vascular access. After DCP, 77 patients (71.3%) had successful reperfusion (modified Thrombolysis In Cerebral Infarction (mTICI) score ≥2b) and 28 (25.9%) were independent (modified Rankin Scale (mRS) score 0-2) at 3 months. 20 complications (18.5%) attributed to DCP occurred, all of them during or within 1 hour of the procedure. Complications led to extension of the intubation time in the intensive care unit in 7 patients (6.4%) and resulted in death in 3 (2.8%). The absence of use of a hemostatic closure device was associated with a higher complication risk (OR 3.04, 95% CI 1.03 to 8.97; p=0043). CONCLUSION In this large multicentric study, DCP was scantly performed for vascular access to perform MT (0.39%) in patients with AIS-LVO and had a high rate of complications (18.5%). Our results provide arguments for not closing the cervical access by manual compression after MT

sj-docx-4-wso-10.1177_17474930231205213 – Supplemental material for Evaluation of mechanical thrombectomy in acute ischemic stroke related to a distal arterial occlusion: A randomized controlled trial

Supplemental material, sj-docx-4-wso-10.1177_17474930231205213 for Evaluation of mechanical thrombectomy in acute ischemic stroke related to a distal arterial occlusion: A randomized controlled trial by Frédéric Clarençon, Isabelle Durand-Zaleski, Kévin Premat, Amandine Baptiste, Emmanuel Chabert, Anna Ferrier, Marc-Antoine Labeyrie, Peggy Reiner, Laurent Spelle, Christian Denier, Titien Tuilier, Hassan Hosseini, Christine Rodriguez-Régent, Guillaume Turc, Cédric Fauché, Matthias Lamy, Bertrand Lapergue, Arturo Consoli, Charlotte Barbier, Marion Boulanger, Nicolas Bricout, Hilde Henon, Benjamin Gory, Sébastien Richard, Aymeric Rouchaud, Francisco Macian-Montoro, Omer Eker, Tae-Hee Cho, Sébastien Soize, Solène Moulin, Jean-Christophe Gentric, Serge Timsit, Jean Darcourt, Jean-François Albucher, Kévin Janot, Mariam Annan, Fernando Pico, Vincent Costalat, Caroline Arquizan, Gautier Marnat, Igor Sibon, Raoul Pop, Valérie Wolff, Eimad Shotar, Stéphanie Lenck, Nader-Antoine Sourour, Anne Radenne, Sonia Alamowitch and Agnès Dechartres in International Journal of Stroke</p

sj-docx-3-wso-10.1177_17474930231205213 – Supplemental material for Evaluation of mechanical thrombectomy in acute ischemic stroke related to a distal arterial occlusion: A randomized controlled trial

Supplemental material, sj-docx-3-wso-10.1177_17474930231205213 for Evaluation of mechanical thrombectomy in acute ischemic stroke related to a distal arterial occlusion: A randomized controlled trial by Frédéric Clarençon, Isabelle Durand-Zaleski, Kévin Premat, Amandine Baptiste, Emmanuel Chabert, Anna Ferrier, Marc-Antoine Labeyrie, Peggy Reiner, Laurent Spelle, Christian Denier, Titien Tuilier, Hassan Hosseini, Christine Rodriguez-Régent, Guillaume Turc, Cédric Fauché, Matthias Lamy, Bertrand Lapergue, Arturo Consoli, Charlotte Barbier, Marion Boulanger, Nicolas Bricout, Hilde Henon, Benjamin Gory, Sébastien Richard, Aymeric Rouchaud, Francisco Macian-Montoro, Omer Eker, Tae-Hee Cho, Sébastien Soize, Solène Moulin, Jean-Christophe Gentric, Serge Timsit, Jean Darcourt, Jean-François Albucher, Kévin Janot, Mariam Annan, Fernando Pico, Vincent Costalat, Caroline Arquizan, Gautier Marnat, Igor Sibon, Raoul Pop, Valérie Wolff, Eimad Shotar, Stéphanie Lenck, Nader-Antoine Sourour, Anne Radenne, Sonia Alamowitch and Agnès Dechartres in International Journal of Stroke</p

sj-docx-1-wso-10.1177_17474930231205213 – Supplemental material for Evaluation of mechanical thrombectomy in acute ischemic stroke related to a distal arterial occlusion: A randomized controlled trial

Supplemental material, sj-docx-1-wso-10.1177_17474930231205213 for Evaluation of mechanical thrombectomy in acute ischemic stroke related to a distal arterial occlusion: A randomized controlled trial by Frédéric Clarençon, Isabelle Durand-Zaleski, Kévin Premat, Amandine Baptiste, Emmanuel Chabert, Anna Ferrier, Marc-Antoine Labeyrie, Peggy Reiner, Laurent Spelle, Christian Denier, Titien Tuilier, Hassan Hosseini, Christine Rodriguez-Régent, Guillaume Turc, Cédric Fauché, Matthias Lamy, Bertrand Lapergue, Arturo Consoli, Charlotte Barbier, Marion Boulanger, Nicolas Bricout, Hilde Henon, Benjamin Gory, Sébastien Richard, Aymeric Rouchaud, Francisco Macian-Montoro, Omer Eker, Tae-Hee Cho, Sébastien Soize, Solène Moulin, Jean-Christophe Gentric, Serge Timsit, Jean Darcourt, Jean-François Albucher, Kévin Janot, Mariam Annan, Fernando Pico, Vincent Costalat, Caroline Arquizan, Gautier Marnat, Igor Sibon, Raoul Pop, Valérie Wolff, Eimad Shotar, Stéphanie Lenck, Nader-Antoine Sourour, Anne Radenne, Sonia Alamowitch and Agnès Dechartres in International Journal of Stroke</p

sj-docx-8-wso-10.1177_17474930231205213 – Supplemental material for Evaluation of mechanical thrombectomy in acute ischemic stroke related to a distal arterial occlusion: A randomized controlled trial

Supplemental material, sj-docx-8-wso-10.1177_17474930231205213 for Evaluation of mechanical thrombectomy in acute ischemic stroke related to a distal arterial occlusion: A randomized controlled trial by Frédéric Clarençon, Isabelle Durand-Zaleski, Kévin Premat, Amandine Baptiste, Emmanuel Chabert, Anna Ferrier, Marc-Antoine Labeyrie, Peggy Reiner, Laurent Spelle, Christian Denier, Titien Tuilier, Hassan Hosseini, Christine Rodriguez-Régent, Guillaume Turc, Cédric Fauché, Matthias Lamy, Bertrand Lapergue, Arturo Consoli, Charlotte Barbier, Marion Boulanger, Nicolas Bricout, Hilde Henon, Benjamin Gory, Sébastien Richard, Aymeric Rouchaud, Francisco Macian-Montoro, Omer Eker, Tae-Hee Cho, Sébastien Soize, Solène Moulin, Jean-Christophe Gentric, Serge Timsit, Jean Darcourt, Jean-François Albucher, Kévin Janot, Mariam Annan, Fernando Pico, Vincent Costalat, Caroline Arquizan, Gautier Marnat, Igor Sibon, Raoul Pop, Valérie Wolff, Eimad Shotar, Stéphanie Lenck, Nader-Antoine Sourour, Anne Radenne, Sonia Alamowitch and Agnès Dechartres in International Journal of Stroke</p

sj-docx-7-wso-10.1177_17474930231205213 – Supplemental material for Evaluation of mechanical thrombectomy in acute ischemic stroke related to a distal arterial occlusion: A randomized controlled trial

Supplemental material, sj-docx-7-wso-10.1177_17474930231205213 for Evaluation of mechanical thrombectomy in acute ischemic stroke related to a distal arterial occlusion: A randomized controlled trial by Frédéric Clarençon, Isabelle Durand-Zaleski, Kévin Premat, Amandine Baptiste, Emmanuel Chabert, Anna Ferrier, Marc-Antoine Labeyrie, Peggy Reiner, Laurent Spelle, Christian Denier, Titien Tuilier, Hassan Hosseini, Christine Rodriguez-Régent, Guillaume Turc, Cédric Fauché, Matthias Lamy, Bertrand Lapergue, Arturo Consoli, Charlotte Barbier, Marion Boulanger, Nicolas Bricout, Hilde Henon, Benjamin Gory, Sébastien Richard, Aymeric Rouchaud, Francisco Macian-Montoro, Omer Eker, Tae-Hee Cho, Sébastien Soize, Solène Moulin, Jean-Christophe Gentric, Serge Timsit, Jean Darcourt, Jean-François Albucher, Kévin Janot, Mariam Annan, Fernando Pico, Vincent Costalat, Caroline Arquizan, Gautier Marnat, Igor Sibon, Raoul Pop, Valérie Wolff, Eimad Shotar, Stéphanie Lenck, Nader-Antoine Sourour, Anne Radenne, Sonia Alamowitch and Agnès Dechartres in International Journal of Stroke</p

sj-docx-6-wso-10.1177_17474930231205213 – Supplemental material for Evaluation of mechanical thrombectomy in acute ischemic stroke related to a distal arterial occlusion: A randomized controlled trial

Supplemental material, sj-docx-6-wso-10.1177_17474930231205213 for Evaluation of mechanical thrombectomy in acute ischemic stroke related to a distal arterial occlusion: A randomized controlled trial by Frédéric Clarençon, Isabelle Durand-Zaleski, Kévin Premat, Amandine Baptiste, Emmanuel Chabert, Anna Ferrier, Marc-Antoine Labeyrie, Peggy Reiner, Laurent Spelle, Christian Denier, Titien Tuilier, Hassan Hosseini, Christine Rodriguez-Régent, Guillaume Turc, Cédric Fauché, Matthias Lamy, Bertrand Lapergue, Arturo Consoli, Charlotte Barbier, Marion Boulanger, Nicolas Bricout, Hilde Henon, Benjamin Gory, Sébastien Richard, Aymeric Rouchaud, Francisco Macian-Montoro, Omer Eker, Tae-Hee Cho, Sébastien Soize, Solène Moulin, Jean-Christophe Gentric, Serge Timsit, Jean Darcourt, Jean-François Albucher, Kévin Janot, Mariam Annan, Fernando Pico, Vincent Costalat, Caroline Arquizan, Gautier Marnat, Igor Sibon, Raoul Pop, Valérie Wolff, Eimad Shotar, Stéphanie Lenck, Nader-Antoine Sourour, Anne Radenne, Sonia Alamowitch and Agnès Dechartres in International Journal of Stroke</p

sj-tif-10-wso-10.1177_17474930231205213 – Supplemental material for Evaluation of mechanical thrombectomy in acute ischemic stroke related to a distal arterial occlusion: A randomized controlled trial

Supplemental material, sj-tif-10-wso-10.1177_17474930231205213 for Evaluation of mechanical thrombectomy in acute ischemic stroke related to a distal arterial occlusion: A randomized controlled trial by Frédéric Clarençon, Isabelle Durand-Zaleski, Kévin Premat, Amandine Baptiste, Emmanuel Chabert, Anna Ferrier, Marc-Antoine Labeyrie, Peggy Reiner, Laurent Spelle, Christian Denier, Titien Tuilier, Hassan Hosseini, Christine Rodriguez-Régent, Guillaume Turc, Cédric Fauché, Matthias Lamy, Bertrand Lapergue, Arturo Consoli, Charlotte Barbier, Marion Boulanger, Nicolas Bricout, Hilde Henon, Benjamin Gory, Sébastien Richard, Aymeric Rouchaud, Francisco Macian-Montoro, Omer Eker, Tae-Hee Cho, Sébastien Soize, Solène Moulin, Jean-Christophe Gentric, Serge Timsit, Jean Darcourt, Jean-François Albucher, Kévin Janot, Mariam Annan, Fernando Pico, Vincent Costalat, Caroline Arquizan, Gautier Marnat, Igor Sibon, Raoul Pop, Valérie Wolff, Eimad Shotar, Stéphanie Lenck, Nader-Antoine Sourour, Anne Radenne, Sonia Alamowitch and Agnès Dechartres in International Journal of Stroke</p

sj-docx-2-wso-10.1177_17474930231205213 – Supplemental material for Evaluation of mechanical thrombectomy in acute ischemic stroke related to a distal arterial occlusion: A randomized controlled trial

Supplemental material, sj-docx-2-wso-10.1177_17474930231205213 for Evaluation of mechanical thrombectomy in acute ischemic stroke related to a distal arterial occlusion: A randomized controlled trial by Frédéric Clarençon, Isabelle Durand-Zaleski, Kévin Premat, Amandine Baptiste, Emmanuel Chabert, Anna Ferrier, Marc-Antoine Labeyrie, Peggy Reiner, Laurent Spelle, Christian Denier, Titien Tuilier, Hassan Hosseini, Christine Rodriguez-Régent, Guillaume Turc, Cédric Fauché, Matthias Lamy, Bertrand Lapergue, Arturo Consoli, Charlotte Barbier, Marion Boulanger, Nicolas Bricout, Hilde Henon, Benjamin Gory, Sébastien Richard, Aymeric Rouchaud, Francisco Macian-Montoro, Omer Eker, Tae-Hee Cho, Sébastien Soize, Solène Moulin, Jean-Christophe Gentric, Serge Timsit, Jean Darcourt, Jean-François Albucher, Kévin Janot, Mariam Annan, Fernando Pico, Vincent Costalat, Caroline Arquizan, Gautier Marnat, Igor Sibon, Raoul Pop, Valérie Wolff, Eimad Shotar, Stéphanie Lenck, Nader-Antoine Sourour, Anne Radenne, Sonia Alamowitch and Agnès Dechartres in International Journal of Stroke</p

sj-docx-5-wso-10.1177_17474930231205213 – Supplemental material for Evaluation of mechanical thrombectomy in acute ischemic stroke related to a distal arterial occlusion: A randomized controlled trial

Supplemental material, sj-docx-5-wso-10.1177_17474930231205213 for Evaluation of mechanical thrombectomy in acute ischemic stroke related to a distal arterial occlusion: A randomized controlled trial by Frédéric Clarençon, Isabelle Durand-Zaleski, Kévin Premat, Amandine Baptiste, Emmanuel Chabert, Anna Ferrier, Marc-Antoine Labeyrie, Peggy Reiner, Laurent Spelle, Christian Denier, Titien Tuilier, Hassan Hosseini, Christine Rodriguez-Régent, Guillaume Turc, Cédric Fauché, Matthias Lamy, Bertrand Lapergue, Arturo Consoli, Charlotte Barbier, Marion Boulanger, Nicolas Bricout, Hilde Henon, Benjamin Gory, Sébastien Richard, Aymeric Rouchaud, Francisco Macian-Montoro, Omer Eker, Tae-Hee Cho, Sébastien Soize, Solène Moulin, Jean-Christophe Gentric, Serge Timsit, Jean Darcourt, Jean-François Albucher, Kévin Janot, Mariam Annan, Fernando Pico, Vincent Costalat, Caroline Arquizan, Gautier Marnat, Igor Sibon, Raoul Pop, Valérie Wolff, Eimad Shotar, Stéphanie Lenck, Nader-Antoine Sourour, Anne Radenne, Sonia Alamowitch and Agnès Dechartres in International Journal of Stroke</p