Thrombectomy outcomes for acute stroke patients with anterior circulation tandem lesions: a clinical registry and an update of a systematic review with meta‐analysis

Sadeh-Gonik, Udi; Tau, Noam; Friehmann, Tal; Bracard, Serge; Anxionnat, René; Derelle, Anne‐Laure; Tonnelet, Romain; Liao, Liang; Richard, Sébastien; Armoiry, Xavier; Gory, Benjamin

doi:10.1111/ene.13577

Cited by 63 publications

(52 citation statements)

References 27 publications

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“…A higher admission NIHSS score, a longer time to recanalization, and the absence of arterial reperfusion were found to be independent risk factors for death, with a mortality rate in our series of 20.2%. These results are in agreement with those previously reported, which describe sICH rates of 5-15% and mortality rates of 13.2-22% [8,12,[16][17][18]22], and they also similar to those published in 2 recent meta-analysis that reported an sICH rate of 7% and a mortality rate of 13-14% [9,10]. Likewise, a recent study found no differences in terms of hemorrhagic complications between patients presenting with an isolated intracranial occlusion compared to tandem occlusions, even after administration of antiplatelet therapy [23].…”

Section: Discussion/conclusionsupporting

confidence: 94%

“…These results are also in line with those reported in acute ischemic stroke with isolated intracranial occlusions [8]. Similar data were reported in 2 recent meta-analyses, with rates of 53% for good clinical outcome at 3 months (95% CI 43-62) in the study of Sadeh-Gonik et al [9] and 44% (95% CI 33-55) in the study of Sivan-Hoffmann et al [10]. Lastly, a subanalysis of the ESCAPE study in patients with tandem occlusions showed a favorable outcome at 3 months in 60% of the cases [11].…”

Section: Discussion/conclusionsupporting

confidence: 91%

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Efficacy and Safety of Endovascular Treatment in Acute Tandem Carotid Occlusions: Analysis of a Single-Center Cohort

Menéndez

Quintana

Valdés

et al. 2020

Cerebrovasc Dis Extra

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Introduction: Acute ischemic strokes with tandem occlusions, which represent 10-20% of all ischemic strokes, have a particularly poor prognosis. Since emergent treatment of tandem lesions has not been specifically addressed in randomized trials, there is an absence of standardized management. Objective: We sought to assess the efficacy and safety of acute endovascular treatment in stroke due to tandem occlusions in our center and compare the results with previous reports. Methods: From a prospective registry we analyzed data of 99 consecutive patients (males: 77.7%, mean age ± SD: 67.5 ± 9.5 years) with stroke due to tandem occlusions who underwent treatment with emergent carotid stenting and intracranial mechanical thrombectomy. Successful recanalization was defined as a TICI score of 2b-3 and a good functional outcome was defined as a modified Rankin scale score ≤2 at 90 days. Symptomatic intracranial hemorrhage (sICH) was considered when associated with worsening on the National Institutes of Health Stroke Scale (≥4 points). Results: A successful recanalization rate was achieved in 87.8 and 48.5% of the patients had a good functional outcome. sICH and mortality rates were 12.1 and 20.2%, respectively, and 21.2% of the patients received combined treatment with intravenous thrombolysis, which did not affect neither the prognosis nor the recanalization or sICH rates. The time from symptom onset to recanalization and the

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Section: Discussion/conclusionsupporting

confidence: 94%

Section: Discussion/conclusionsupporting

confidence: 91%

Efficacy and Safety of Endovascular Treatment in Acute Tandem Carotid Occlusions: Analysis of a Single-Center Cohort

Menéndez

Quintana

Valdés

et al. 2020

Cerebrovasc Dis Extra

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“…The data are synthetized in 2 recently published meta-analyses. 7,11 Most articles reported high recanalization rates with different technical variations of the procedure and identified predictors of successful recanalization and/or good clinical outcome. Surprisingly, there was very little information on the outcome of implanted carotid stents.…”

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

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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 (

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“…In most instances, these examples were explicit about their rationale for incorporating unpublished data, primarily because the published data was sparse or lacked granularity (i.e., to increase certainty of findings by addressing strength of evidence), and/or to determine whether the published data were applicable to health system populations (i.e., to increase the certainty of findings by addressing the applicability of evidence). [5][6][7][8][9][10][11][12][13][14][15][16][17][18] For example, we identified several times that the Mayo Clinic combined local health system data with systematically reviewed published data to support various clinical groups' patient care management decisions, that illustrate different reasons for combining unpublished local data and published data:…”

Section: Inform Strength Application or Implementation Of Evidencementioning

confidence: 99%

“…Based on selected examples, demonstrating concordance can increase the certainty for decision makers and result in practice change or coverage decisions. 12,17,18,22 • Last, we believe this process should be conducted in close partnership with health systems, which ideally includes a range of individuals such as clinical leaders and decision makers as well as QI staff and health system researchers.…”

Section: Recommendationsmentioning

confidence: 99%

Integrating Health System Data With Systematic Reviews: A Framework for When and How Unpublished Health System Data Can Be Used With Systematic Reviews

Lin¹,

Murad²,

Leas³

et al. 2020

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ii Key MessagesPurpose of Report Given that health-system decision making would benefit from both traditional systematic reviews and health-system-specific data, this report investigates when and how to use primary data from health systems in real time with systematic reviews and articulates a framework for using health system data with systematic reviews to support health system decision making. Key MessagesBased on our review of examples and methodologic guidance, as well as our experience conducting systematic reviews for various stakeholders, we recommend five basic principles regarding when and how to use unpublished health system data alongside of systematically reviewed data.• Explicitly state the rationale for using unpublished data (i.e., to improve the strength and applicability of evidence, and/or to inform its implementation).

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Thrombectomy outcomes for acute stroke patients with anterior circulation tandem lesions: a clinical registry and an update of a systematic review with meta‐analysis

Abstract: Our data report an association between acute stenting and successful reperfusion rates in stroke patients with tandem lesion treated with MT. Further studies are warranted to determine the intracranial bleeding risk after MT and stenting according to the antiplatelet therapy.

Cited by 63 publications

References 27 publications

Efficacy and Safety of Endovascular Treatment in Acute Tandem Carotid Occlusions: Analysis of a Single-Center Cohort

Efficacy and Safety of Endovascular Treatment in Acute Tandem Carotid Occlusions: Analysis of a Single-Center Cohort

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

Integrating Health System Data With Systematic Reviews: A Framework for When and How Unpublished Health System Data Can Be Used With Systematic Reviews

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