TY - JOUR
T1 - Thrombectomy in acute stroke with tandem occlusions from dissection versus atherosclerotic cause
AU - TITAN Investigators
AU - Gory, Benjamin
AU - Piotin, Michel
AU - Haussen, Diogo C.
AU - Steglich-Arnholm, Henrik
AU - Holtmannspötter, Markus
AU - Labreuche, Julien
AU - Taschner, Christian
AU - Eiden, Sebastian
AU - Nogueira, Raul G.
AU - Papanagiotou, Panagiotis
AU - Boutchakova, Maria
AU - Siddiqui, Adnan
AU - Lapergue, Bertrand
AU - Dorn, Franziska
AU - Cognard, Christophe
AU - Killer-Oberpfalzer, Monika
AU - Mangiafico, Salvatore
AU - Ribo, Marc
AU - Behme, Daniel
AU - Spiotta, Alejandro M.
AU - Mazighi, Mikael
AU - Turjman, Francis
N1 - Publisher Copyright:
© 2017 American Heart Association, Inc.
PY - 2017/11
Y1 - 2017/11
N2 - Background and Purpose-Tandem steno-occlusive lesions were poorly represented in randomized trials and represent a major challenge for endovascular thrombectomy in acute anterior circulation strokes. The impact of the cervical carotid lesion cause (ie, atherosclerotic versus dissection) on outcome of tandem patients endovascularly treated remains to be assessed. Methods-We retrospectively analyzed individual data of prospectively collected consecutive tandem patients treated with endovascular thrombectomy. The primary outcome was favorable outcome at 90 days (modified Rankin Scale score of 0-2). Secondary efficacy outcomes included successful reperfusion (modified Thrombolysis in Cerebrovascular Infarction scores of 2b-3), time to reperfusion, and safety outcomes encompassed procedural complications, symptomatic intracerebral hemorrhage, and 90-day mortality. Results-Among the 295 included patients, 65 had cervical carotid dissection and 230 had cervical carotid atherosclerotic cause. The rate of favorable outcome was 56.3% in the dissection group versus 47.6% in the atherosclerotic arm (center-, age-, and admission National Institutes of Health Stroke Scale-adjusted odds ratio, 1.08; 95% confidence interval, 0.50-2.30; P=0.85). No significant differences were observed in secondary outcomes. The rates of successful reperfusion, symptomatic intracerebral hemorrhage, and 90-day mortality were 78.5% versus 74.5% (P=0.13), 4.6% versus 5.2% (P=1.0), and 7.8% versus 15.3% (P=0.94) in the dissection versus atherosclerotic groups, respectively. The median procedural time was 76 minutes (interquartile range, 52-95 minutes) in the dissection group and 67 minutes (interquartile range, 45-98 minutes) in the atherosclerotic group (P=0.24). Conclusions-We found no differences in the outcomes of patients with anterior circulation tandem atherosclerotic and dissection lesions treated with endovascular thrombectomy. Further studies are warranted. (Stroke. 2017;48:3145-3148. DOI: 10.1161/STROKEAHA.117.018264).
AB - Background and Purpose-Tandem steno-occlusive lesions were poorly represented in randomized trials and represent a major challenge for endovascular thrombectomy in acute anterior circulation strokes. The impact of the cervical carotid lesion cause (ie, atherosclerotic versus dissection) on outcome of tandem patients endovascularly treated remains to be assessed. Methods-We retrospectively analyzed individual data of prospectively collected consecutive tandem patients treated with endovascular thrombectomy. The primary outcome was favorable outcome at 90 days (modified Rankin Scale score of 0-2). Secondary efficacy outcomes included successful reperfusion (modified Thrombolysis in Cerebrovascular Infarction scores of 2b-3), time to reperfusion, and safety outcomes encompassed procedural complications, symptomatic intracerebral hemorrhage, and 90-day mortality. Results-Among the 295 included patients, 65 had cervical carotid dissection and 230 had cervical carotid atherosclerotic cause. The rate of favorable outcome was 56.3% in the dissection group versus 47.6% in the atherosclerotic arm (center-, age-, and admission National Institutes of Health Stroke Scale-adjusted odds ratio, 1.08; 95% confidence interval, 0.50-2.30; P=0.85). No significant differences were observed in secondary outcomes. The rates of successful reperfusion, symptomatic intracerebral hemorrhage, and 90-day mortality were 78.5% versus 74.5% (P=0.13), 4.6% versus 5.2% (P=1.0), and 7.8% versus 15.3% (P=0.94) in the dissection versus atherosclerotic groups, respectively. The median procedural time was 76 minutes (interquartile range, 52-95 minutes) in the dissection group and 67 minutes (interquartile range, 45-98 minutes) in the atherosclerotic group (P=0.24). Conclusions-We found no differences in the outcomes of patients with anterior circulation tandem atherosclerotic and dissection lesions treated with endovascular thrombectomy. Further studies are warranted. (Stroke. 2017;48:3145-3148. DOI: 10.1161/STROKEAHA.117.018264).
KW - Atherosclerosis
KW - Carotid
KW - Dissection
KW - Stents
KW - Stroke
KW - Thrombectomy
UR - https://www.scopus.com/pages/publications/85032151364
U2 - 10.1161/STROKEAHA.117.018264
DO - 10.1161/STROKEAHA.117.018264
M3 - Article
C2 - 28974628
AN - SCOPUS:85032151364
SN - 0039-2499
VL - 48
SP - 3145
EP - 3148
JO - Stroke
JF - Stroke
IS - 11
ER -