B Gory1, D C Haussen2, M Piotin3, H Steglich-Arnholm4, M Holtmannspötter5, J Labreuche6, M Kyheng6, C Taschner7, S Eiden7, R G Nogueira2, P Papanagiotou8, M Boutchakova8, A H Siddiqui9, B Lapergue10, F Dorn11, C Cognard12, M Killer13, S Mangiafico14, M Ribo15, M N Psychogios16, A M Spiotta17, M A Labeyrie18, A Biondi19, M Mazighi3, F Turjman20. 1. Department of Diagnostic and Interventional Neuroradiology, INSERM U947, University Hospital of Nancy, Nancy, France. 2. Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta, GA, USA. 3. Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France. 4. Department of Neurology, Rigshospitalet, Copenhagen. 5. Department of Neuroradiology, Rigshospitalet, Copenhagen, Denmark. 6. Department of Biostatistics, EA2694-Santé Publique: Epidémiologie et Qualité Des Soins, Lille University, Lille, France. 7. Department of Neuroradiology, Medical Center-University of Freiburg, Freiburg. 8. Department of Diagnostic and Interventional Neuroradiology, Klinikum Bremen-Mitte/Bremen-Ost, Bremen, Germany. 9. Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, NY, USA. 10. Department of Neurology, Stroke Center, Foch Hospital, Suresnes, France. 11. Department of Neuroradiology, University Hospital of Munich, Munich, Germany. 12. Department of Neuroradiology, University Hospital of Toulouse, Toulouse, France. 13. Department of Neuroradiology, Christian Doppler Clinic, Research Institute for Neurointervention, Paracelsus Medical University, Salzburg, Austria. 14. Department of Interventional Neuroradiology, Careggi University Hospital, Florence, Italy. 15. Department of Neurology, Hospital Vall D'Hebron, Barcelona, Spain. 16. Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany. 17. Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA. 18. Department of Interventional Neuroradiology, Lariboisière Hospital, Paris. 19. Department of Neuroradiology and Endovascular Therapeutic, University Hospital of Besançon, Besançon. 20. Department of Interventional Neuroradiology, Hospices Civils de Lyon, Lyon, France.
Abstract
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.
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.
Authors: V Da Ros; J Scaggiante; F Sallustio; S Lattanzi; M Bandettini; A Sgreccia; C Rolla-Bigliani; E Lafe; G Sanfilippo; M Diomedi; M Ruggiero; N Haznedari; M Giannoni; C Finocchi; R Floris Journal: AJNR Am J Neuroradiol Date: 2020-09-24 Impact factor: 3.825
Authors: R Pop; A Hasiu; P H Mangin; F Severac; D Mihoc; D Nistoran; M Manisor; M Simu; S Chibbaro; R Gheoca; V Quenardelle; O Rouyer; V Wolff; R Beaujeux Journal: AJNR Am J Neuroradiol Date: 2021-02-18 Impact factor: 3.825
Authors: Diogo C Haussen; Francis Turjman; Michel Piotin; Julien Labreuche; Henrik Steglich-Arnholm; Markus Holtmannspötter; Christian Taschner; Sebastian Eiden; Raul G Nogueira; Panagiotis Papanagiotou; Maria Boutchakova; Adnan H Siddiqui; Bertrand Lapergue; Franziska Dorn; Christophe Cognard; Monika Killer; Salvatore Mangiafico; Marc Ribo; Marios N Psychogios; Alejandro M Spiotta; Marc-Antoine Labeyrie; Mikael Mazighi; Alessandra Biondi; Sébastien Richard; Jonathan A Grossberg; René Anxionnat; Serge Bracard; Benjamin Gory Journal: Interv Neurol Date: 2019-02-15
Authors: Neal M Nolan; Robert W Regenhardt; Matthew J Koch; Scott B Raymond; Christopher J Stapleton; James D Rabinov; Scott B Silverman; Thabele M Leslie-Mazwi; Aman B Patel Journal: J Stroke Cerebrovasc Dis Date: 2020-11-26 Impact factor: 2.136