{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,11]],"date-time":"2026-11-11T08:16:53Z","timestamp":1794385013711,"version":"4.9.0"},"reference-count":66,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J NeuroIntervent Surg"],"accepted":{"date-parts":[[2022,3,24]]},"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Emergent carotid artery stenting (eCAS) is performed during mechanical thrombectomy for acute ischemic stroke due to tandem occlusion. However, the optimal management strategy in this setting is still unclear.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To carry out a systematic review and meta-analysis to investigate the safety and efficacy of eCAS in patients with tandem occlusion.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Systematic review followed the PRISMA guidelines. Medline, EMBASE, and Scopus were searched from January 1, 2004 to March 7, 2022 for studies evaluating eCAS and no-stenting approach in patients with stroke with tandem occlusion. Primary endpoint was the 90-day modified Rankin Scale score 0\u20132; secondary outcomes were (1) symptomatic intracerebral hemorrhage (sICH), (2) recurrent stroke, (3) successful recanalization (Thrombolysis in Cerebral Infarction score 2b\u20133), (4) embolization in new territories, and (5) restenosis rate. Meta-analysis was performed using the Mantel-Haenszel method and random-effects modeling.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Forty-six studies reached synthesis. eCAS was associated with higher good functional outcome compared with the no-stenting approach (OR=1.52, 95% CI 1.19 to 1.95), despite a significantly increased risk of sICH (OR=1.97, 95% CI 1.23 to 3.15), and higher successful recanalization rate (OR=1.91, 95% CI 1.29 to 2.85). Restenosis rate was lower in the eCAS group than in the no-stenting group (2% vs 9%, p=0.001). Recanalization rate was higher in retrograde than antegrade eCAS (OR=0.51, 95% CI 0.28 to 0.93). Intraprocedural antiplatelets during eCAS were associated with higher rate of good functional outcome (60% vs 46%, p=0.016) and lower rate of sICH (7% vs 11%; p=0.08) compared with glycoprotein IIb\/IIIa inhibitors.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In observational studies, eCAS seems to be associated with higher good functional outcome than no-stenting in patients with acute ischemic stroke due to tandem occlusion, despite the higher risk of sICH. Dedicated trials are needed to confirm these results.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/neurintsurg-2022-018683","type":"journal-article","created":{"date-parts":[[2022,4,15]],"date-time":"2022-04-15T13:25:36Z","timestamp":1650029136000},"page":"428-433","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":46,"title":["Emergent carotid stenting versus no stenting for acute ischemic stroke due to tandem occlusion: a meta-analysis"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3245-917X","authenticated-orcid":false,"given":"Francesco","family":"Diana","sequence":"first","affiliation":[{"name":"Neuroradiology, University Hospital 'San Giovanni di Dio e Ruggi d\u2019Aragona', Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Romoli","sequence":"additional","affiliation":[{"name":"Neurology and Stroke Unit, Maurizio Bufalini Hospital, Cesena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giada","family":"Toccaceli","sequence":"additional","affiliation":[{"name":"Emergency Neurosurgery, Ospedale Civile 'Santo Spirito', Pescara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aymeric","family":"Rouchaud","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology, University Hospital Centre of Limoges, Limoges, France"},{"name":"BioEMXLim, University of Limoges Medical Faculty, Limoges, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charbel","family":"Mounayer","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology, University Hospital Centre of Limoges, Limoges, France"},{"name":"BioEMXLim, University of Limoges Medical Faculty, Limoges, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele Giuseppe","family":"Romano","sequence":"additional","affiliation":[{"name":"Neuroradiology, University Hospital 'San Giovanni di Dio e Ruggi d\u2019Aragona', Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Di Salle","sequence":"additional","affiliation":[{"name":"Medicine, Surgery and Dentistry \"Scuola Medica Salernitana\", University of Salerno, Fisciano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Missori","sequence":"additional","affiliation":[{"name":"Human Neurosciences, Neurosurgery, University of Rome La Sapienza, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Zini","sequence":"additional","affiliation":[{"name":"Neurology and Stroke Center, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6702-7924","authenticated-orcid":false,"given":"Diana","family":"Aguiar de Sousa","sequence":"additional","affiliation":[{"name":"Neurosciences and Mental Health, Neurology Service, Hospital de Santa Maria\/CHULN, University of Lisbon, Santa Maria, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3920-8517","authenticated-orcid":false,"given":"Simone","family":"Peschillo","sequence":"additional","affiliation":[{"name":"Surgical Medical Sciences and Advanced Technologies \"G.F. 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