Impact of intravenous thrombolysis and emergent carotid stenting on reperfusion and clinical outcomes in patients with acute stroke with tandem lesion treated with thrombectomy: a collaborative pooled analysis

Gory, Benjamin; Haussen, Diogo C; Piotin, Michel; Steglich-Arnholm, Henrik; Holtmannspötter, M.; Labreuche, Julien; Kyheng, Maéva; Taschner, Christian; Eiden, Sebastian; Nogueira, Raul G; Papanagiotou, Panagiotis; Boutchakova, Maria; Siddiqui, Adnan H.; Lapergue, Bertrand; Dorn, Franziska; Cognard, Christophe; Killer, Monika; Mangiafico, Salvatore; Ribó, Marc; Psychogios, Marios; Spiotta, Alejandro M; Labeyrie, Marc‐Antoine; Biondi, Alessandra; Mazighi, Mikaël; Turjman, Francis

doi:10.1111/ene.13633

Cited by 63 publications

(52 citation statements)

References 16 publications

(21 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patient eligibility and methods of TITAN collaboration have been previously reported [7, 8]. Patients were included in the present study, if there was an association of a large vessel intracranial occlusion (intracranial internal carotid or middle cerebral artery M1/M2) and an atherosclerotic cervical internal carotid artery (ICA) lesion (complete occlusion or stenosis ≥90% by NASCET criteria on baseline catheter-angiography angiogram).…”

Section: Methodsmentioning

confidence: 99%

Head or Neck First? Speed and Rates of Reperfusion in Thrombectomy for Tandem Large Vessel Occlusion Strokes

et al. 2019

Self Cite

View full text Add to dashboard Cite

Background: We aim to evaluate the speed and rates of reperfusion in tandem large vessel occlusion acute stroke patients undergoing upfront cervical lesion treatment (Neck-First: angioplasty and/or stent before thrombectomy) as compared to direct intracranial occlusion therapy (Head-First) in a large international multicenter cohort. Methods: The Thrombectomy In TANdem Lesions (TITAN) collaboration pooled individual data of prospectively collected thrombectomy international databases for all consecutive anterior circulation tandem patients who underwent emergent thrombectomy. The co-primary outcome measures were rates of successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b/3) and time from groin puncture to successful reperfusion. Results: In total, 289 patients with tandem atherosclerotic etiology were included in the analysis (182 Neck-First and 107 Head-First patients). Except for differences in the Alberta Stroke Program Early CT Score (ASPECTS; median 8 [range 7–10] Neck-First vs. 7 [range 6–8] Head-First; p < 0.001) and cervical internal carotid artery (ICA) lesion severity (complete occlusion in 35% of the Neck-First vs. 57% of the Head-First patients; p < 0.001), patient characteristics were well balanced. After adjustments, there was no difference in successful reperfusion rates between the study groups (odds ratio associated with Neck-First: 1.18 [95% confidence interval, 0.60–2.17]). The time to successful reperfusion from groin puncture was significantly shorter in the Head-First group after adjustments (median 56 min [range 39–90] vs. 70 [range 50–102]; p = 0.001). No significant differences in the rates of full reperfusion, symptomatic hemorrhage, 90-day independence, or mortality were observed. Sensitivity analysis excluding patients with complete cervical ICA occlusion yielded similar results. Conclusions: The upfront approach of the intracranial lesion in patients with tandem large vessel occlusion strokes leads to similar reperfusion rates but faster reperfusion as compared to initial cervical revascularization followed by mechanical thrombectomy. Controlled studies are warranted.

show abstract

Section: Methodsmentioning

confidence: 99%

Head or Neck First? Speed and Rates of Reperfusion in Thrombectomy for Tandem Large Vessel Occlusion Strokes

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…In many publications, [12][13][14][15][16][17][18][19][20][21] there is no mention of postprocedural stent patency. Other groups communicate partial data: Sadeh-Gonik et al 11 studied 43 patients; they reported 1 delayed stent thrombosis of 8 cases with available imaging follow-up (12.5%).…”

Section: Discussionmentioning

confidence: 99%

Predictors and Clinical Impact of Delayed Stent Thrombosis after Thrombectomy for Acute Stroke with Tandem Lesions

Pop¹,

Зинченко²,

Quenardelle³

et al. 2019

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

BACKGROUND AND PURPOSE: There are very few published data on the patency of carotid stents implanted during thrombectomies for tandem lesions in the anterior circulation. We aimed to communicate our experience of stenting in the acute setting with systematic follow-up of stent patency and discuss predictors and clinical repercussions of delayed stent thrombosis. MATERIALS AND METHODS: We performed a retrospective study of stroke thrombectomies in a single center between January 2009 and April 2018. Patient files were reviewed to extract patient characteristics, procedural details, imaging studies, and clinical information. Predictors of delayed stent thrombosis and clinical outcome at discharge were analyzed using univariate and multivariate analyses. RESULTS: We identified 81 patients treated for tandem lesions: 63 (77.7%) atheromas, 17 (20.9%) dissections, and 1 (1.2%) carotid web. TICI 2b-3 recanalization was achieved in 70 (86.4%) cases. Thirty-five patients (43.2%) were independent (mRS score Յ 2) at discharge. Among 73 patients with intracranial recanalization and patent stents at the end of the procedure, delayed stent thrombosis was observed in 14 (19.1%). Among 59 patients with patent stents, 44 had further imaging controls (median, 105 days; range, 2-2407 days) and 1 (1.6%) had 50% in-stent stenosis with no retreatment. Stent occlusion rates were 11/39 (28.2%) for periprocedural aspirin treatment versus 3/34 (8.8%) for aspirin and clopidogrel (P ϭ .04). Delayed stent thrombosis was independently associated with higher admission NIHSS scores (

show abstract

“…When IV t‐PA prior to MT is administered to a proportion of 63.5% of patients, and a similar fraction receives post‐treatment antiplatelet therapy and heparin in 23.5% of the patients, this has to be borne in mind as enhancing a known risk for serious haemorrhages. Indeed, a symptomatic intracranial haemorrhage was reported in 5.3% [ n = 21; 95% confidence interval (CI) 3.1%–7.6%] of the patients in this cohort where all‐cause mortality reached 13.2% ( n = 52, 95% CI 9.8%–16.6%) .…”

mentioning

confidence: 82%

“…The investigators of the Thrombectomy in Tandem Lesions (TITAN) trial can be congratulated for the overall result, 52.2% of patients achieving a good outcome (modified Rankin Scale score 0–2) at 90 days in this demanding stroke patient population (mean admission National Institutes of Health Stroke Scale score 15.8), where reperfusion times are longer than in isolated intracranial occlusions . Rather reassuringly, the two initial therapeutic approaches (IV t‐PA and carotid stenting) were independently associated with successful reperfusion, which was achieved in 76.7% of the 395 patients.…”

mentioning

confidence: 99%

“…To sum up, whilst available evidence proves that early MT improves outcome, the TITAN study has shown comparable outcomes in occlusions with tandem lesions . But it takes additional rigorously controlled studies with field randomization to demonstrate the true significance of IV t‐PA pretreatment in LVOs and whether rapid on‐scene clinical scoring can justify bypassing IV t‐PA and primary stroke centres in suspected LVOs needing immediate MT.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Time well spent in recanalizing complex cerebrovascular occlusions

Lindsberg

2018

Euro J of Neurology

View full text Add to dashboard Cite

show abstract

Impact of intravenous thrombolysis and emergent carotid stenting on reperfusion and clinical outcomes in patients with acute stroke with tandem lesion treated with thrombectomy: a collaborative pooled analysis

Abstract: 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.

Cited by 63 publications

References 16 publications

Head or Neck First? Speed and Rates of Reperfusion in Thrombectomy for Tandem Large Vessel Occlusion Strokes

Head or Neck First? Speed and Rates of Reperfusion in Thrombectomy for Tandem Large Vessel Occlusion Strokes

Predictors and Clinical Impact of Delayed Stent Thrombosis after Thrombectomy for Acute Stroke with Tandem Lesions

Time well spent in recanalizing complex cerebrovascular occlusions

Contact Info

Product

Resources

About