TY - JOUR
T1 - Impact of intravenous thrombolysis and emergent carotid stenting on reperfusion and clinical outcomes in patients with acute stroke with tandem lesion treated with thrombectomy
T2 - a collaborative pooled analysis
AU - the Thrombectomy In TANdem lesions (TITAN) investigators
AU - Gory, B.
AU - Haussen, D. C.
AU - Piotin, M.
AU - Steglich-Arnholm, H.
AU - Holtmannspötter, M.
AU - Labreuche, J.
AU - Kyheng, M.
AU - Taschner, C.
AU - Eiden, S.
AU - Nogueira, R. G.
AU - Papanagiotou, P.
AU - Boutchakova, M.
AU - Siddiqui, A. H.
AU - Lapergue, B.
AU - Dorn, F.
AU - Cognard, C.
AU - Killer, M.
AU - Mangiafico, S.
AU - Ribo, M.
AU - Psychogios, M. N.
AU - Spiotta, A. M.
AU - Labeyrie, M. A.
AU - Biondi, A.
AU - Mazighi, M.
AU - Turjman, F.
AU - Jossan, Claire
AU - Kastrup, Andreas
AU - Grossberg, Jonathan Andrew
AU - Guenego, Adrien
AU - Darcourt, Julien
AU - Vukasinovic, Isabelle
AU - Pomero, Elisa
AU - Davies, Jason
AU - Renieri, Leonardo
AU - Hecker, Corentin
AU - Muchada, Maria
AU - Consoli, Arturo
AU - Rodesch, Georges
AU - Houdart, Emmanuel
AU - Turner, Raymond
AU - Turk, Aquilla
AU - Chaudry, Imran
AU - Labeyrie, Paul Emile
AU - Riva, Roberto
AU - Lockau, Johanna
AU - Blanc, Raphaël
AU - Redjem, Hocine
AU - Behme, Daniel
AU - Shallwani, Hussain
AU - Christopher, Maurer
N1 - Publisher Copyright:
© 2018 EAN
PY - 2018/9
Y1 - 2018/9
N2 - Background and purpose: Tandem anterior circulation lesions in the setting of acute ischemic stroke (AIS) are a complex endovascular situation that has not been specifically addressed in trials. We determined the predictors of successful reperfusion and good clinical outcome at 90 days after mechanical thrombectomy (MT) in patients with AIS with tandem lesions in a pooled collaborative study. Methods: This was a retrospective analysis of consecutive patients presenting to 18 comprehensive stroke centers with AIS due to tandem lesion of the anterior circulation who underwent MT. Results: A total of 395 patients were included. Successful reperfusion (modified thrombolysis in cerebral infarction score 2b–3) was achieved in 76.7%. At 90 days, 52.2% achieved a good outcome (modified Rankin Scale score 0–2), 13.8% suffered a parenchymal hematoma and 13.2% were dead. Lower National Institutes of Health Stroke Scale score [odds ratio (OR), 1.26; 95% confidence intervals (CI), 1.07–1.48, P = 0.004], Alberta Stroke Program Early CT Score ≥7 (OR, 2.00; 95% CI, 1.07–3.43, P = 0.011), intravenous thrombolysis (OR, 1.47; 95% CI, 1.01–2.12, P = 0.042) and stenting of the extracranial carotid lesion (OR, 1.63; 95% CI, 1.04–2;53, P = 0.030) were independently associated with successful reperfusion. Lower age (OR, 1.58; 95% CI, 1.26–1.97, P < 0.001), absence of hypercholesterolemia (OR, 1.77; 95% CI, 1.10–2.84, P = 0.018), lower National Institutes of Health Stroke Scale scores (OR, 2.04; 95% CI, 1.53–2.72, P < 0.001), Alberta Stroke Program Early CT Score ≥7 (OR, 2.75; 95% CI, 1.24–6.10, P = 0.013) and proximal middle cerebral artery occlusion (OR, 1.59; 95% CI, 1.03–2.44, P = 0.035) independently predicted a good 90-day outcome. Conclusions: Intravenous thrombolysis and emergent stenting of the extracranial carotid lesion were predictors of a successful reperfusion after MT of patients with AIS with tandem lesion of the anterior circulation.
AB - Background and purpose: Tandem anterior circulation lesions in the setting of acute ischemic stroke (AIS) are a complex endovascular situation that has not been specifically addressed in trials. We determined the predictors of successful reperfusion and good clinical outcome at 90 days after mechanical thrombectomy (MT) in patients with AIS with tandem lesions in a pooled collaborative study. Methods: This was a retrospective analysis of consecutive patients presenting to 18 comprehensive stroke centers with AIS due to tandem lesion of the anterior circulation who underwent MT. Results: A total of 395 patients were included. Successful reperfusion (modified thrombolysis in cerebral infarction score 2b–3) was achieved in 76.7%. At 90 days, 52.2% achieved a good outcome (modified Rankin Scale score 0–2), 13.8% suffered a parenchymal hematoma and 13.2% were dead. Lower National Institutes of Health Stroke Scale score [odds ratio (OR), 1.26; 95% confidence intervals (CI), 1.07–1.48, P = 0.004], Alberta Stroke Program Early CT Score ≥7 (OR, 2.00; 95% CI, 1.07–3.43, P = 0.011), intravenous thrombolysis (OR, 1.47; 95% CI, 1.01–2.12, P = 0.042) and stenting of the extracranial carotid lesion (OR, 1.63; 95% CI, 1.04–2;53, P = 0.030) were independently associated with successful reperfusion. Lower age (OR, 1.58; 95% CI, 1.26–1.97, P < 0.001), absence of hypercholesterolemia (OR, 1.77; 95% CI, 1.10–2.84, P = 0.018), lower National Institutes of Health Stroke Scale scores (OR, 2.04; 95% CI, 1.53–2.72, P < 0.001), Alberta Stroke Program Early CT Score ≥7 (OR, 2.75; 95% CI, 1.24–6.10, P = 0.013) and proximal middle cerebral artery occlusion (OR, 1.59; 95% CI, 1.03–2.44, P = 0.035) independently predicted a good 90-day outcome. Conclusions: Intravenous thrombolysis and emergent stenting of the extracranial carotid lesion were predictors of a successful reperfusion after MT of patients with AIS with tandem lesion of the anterior circulation.
KW - arterial dissection
KW - cerebral infarction
KW - endovascular procedures
KW - intensive care
KW - medication
KW - stroke
UR - https://www.scopus.com/pages/publications/85045269270
U2 - 10.1111/ene.13633
DO - 10.1111/ene.13633
M3 - Article
C2 - 29575634
AN - SCOPUS:85045269270
SN - 1351-5101
VL - 25
SP - 1115
EP - 1120
JO - European Journal of Neurology
JF - European Journal of Neurology
IS - 9
ER -