Panagiotis Papanagiotou1, Diogo C Haussen2, Francis Turjman3, Julien Labreuche4, Michel Piotin5, Andreas Kastrup6, Henrik Steglich-Arnholm7, Markus Holtmannspötter8, Christian Taschner9, Sebastian Eiden9, Raul G Nogueira2, Maria Boutchakova10, Adnan Siddiqui11, Bertrand Lapergue12, Franziska Dorn13, Christophe Cognard14, Monika Killer15, Salvatore Mangiafico16, Marc Ribo17, Marios N Psychogios18, Alejandro Spiotta19, Marc Antoine Labeyrie20, Alessandra Biondi21, Mikaël Mazighi5, Sébastien Richard22, René Anxionnat23, Serge Bracard23, Benjamin Gory23. 1. Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte/Bremen-Ost, Bremen, Germany. Electronic address: papanagiotou@me.com. 2. Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta, Georgia. 3. Department of Interventional Neuroradiology, Hospices Civils de Lyon, Lyon, France. 4. University Lille, CHU Lille, Santé publique: épidémiologie et qualité des soins, Lille, France. 5. Department of Interventional Neuroradiology, Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild, Paris, France. 6. Department of Neurology, Hospital Bremen-Mitte, Bremen, Germany. 7. Department of Neurology, Rigshospitalet, Copenhagen, Denmark. 8. Department of Neuroradiology, Rigshospitalet, Copenhagen, Denmark. 9. Department of Neuroradiology, Medical Center-University of Freiburg, Freiburg, Germany. 10. Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte/Bremen-Ost, Bremen, Germany. 11. Department of Neurosurgery, State University of New York, Buffalo, New York. 12. Department of Neurology, Stroke Center, Foch Hospital, Suresnes, France. 13. Department of Neuroradiology, University Hospital of Munich, Munich, Germany. 14. Department of Neuroradiology, University Hospital of Toulouse, Toulouse, France. 15. Department of Neurology/Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria. 16. Department of Interventional Neuroradiology, Careggi University Hospital, Florence, Italy. 17. Department of Neurology, Hospital Vall D'Hebron, Barcelona, Spain. 18. Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany. 19. Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina. 20. Department of Interventional Neuroradiology, Lariboisière Hospital, Paris, France. 21. Department of Neuroradiology and Endovascular Therapeutic, University Hospital of Besançon, Besançon, France. 22. Department Neurology, Stroke Unit, University Hospital of Nancy, Nancy, France. 23. Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, University of Lorraine, Nancy, France.
Abstract
OBJECTIVES: The aim of this study was to identify the optimal endovascular approach in patients with acute stroke with tandem lesions. BACKGROUND: At present, there is no consensus about the ideal technical strategy for the endovascular treatment of patients with acute ischemic stroke with tandem lesions of the extracranial internal carotid artery (ICA) and intracranial cerebral arteries. METHODS: This was an international, multicenter registry with a total of 482 patients with acute ischemic stroke and tandem lesions. Patients were treated by intracranial thrombectomy as well as 1 of the following 4 strategies: 1) acute carotid artery stenting of the extracranial ICA with antithrombotic agents; 2) acute carotid artery stenting of the extracranial ICA without antithrombotic agents; 3) balloon angioplasty of the extracranial ICA; and 4) intracranial thrombectomy alone. The main outcome endpoints of the study were the degree of recanalization and the 90-day clinical outcome. The safety endpoints were symptomatic intracerebral hemorrhage and all causes of mortality at 90 days. RESULTS: Using univariate analysis, the rates of successful reperfusion (modified Thrombolysis in Cerebral Infarction grades 2B and 3) and favorable clinical outcome after 90 days were significantly higher after acute carotid stenting with antithrombotic therapy and thrombectomy compared with the group with thrombectomy alone. After adjusting for confounding variables, acute stenting with antithrombotic therapy was independently associated with successful recanalization (odds ratio: 2.4; 95% confidence interval: 1.25 to 4.59; p = 0.008). The rates of symptomatic intracerebral hemorrhage and 90-day mortality were comparable among all 4 treatment groups. CONCLUSIONS: Acute stenting of the extracranial ICA with antithrombotic therapy in combination with intracranial thrombectomy is associated with higher recanalization rates in treatment of patients with acute stroke with tandem lesions.
OBJECTIVES: The aim of this study was to identify the optimal endovascular approach in patients with acute stroke with tandem lesions. BACKGROUND: At present, there is no consensus about the ideal technical strategy for the endovascular treatment of patients with acute ischemic stroke with tandem lesions of the extracranial internal carotid artery (ICA) and intracranial cerebral arteries. METHODS: This was an international, multicenter registry with a total of 482 patients with acute ischemic stroke and tandem lesions. Patients were treated by intracranial thrombectomy as well as 1 of the following 4 strategies: 1) acute carotid artery stenting of the extracranial ICA with antithrombotic agents; 2) acute carotid artery stenting of the extracranial ICA without antithrombotic agents; 3) balloon angioplasty of the extracranial ICA; and 4) intracranial thrombectomy alone. The main outcome endpoints of the study were the degree of recanalization and the 90-day clinical outcome. The safety endpoints were symptomatic intracerebral hemorrhage and all causes of mortality at 90 days. RESULTS: Using univariate analysis, the rates of successful reperfusion (modified Thrombolysis in Cerebral Infarction grades 2B and 3) and favorable clinical outcome after 90 days were significantly higher after acute carotid stenting with antithrombotic therapy and thrombectomy compared with the group with thrombectomy alone. After adjusting for confounding variables, acute stenting with antithrombotic therapy was independently associated with successful recanalization (odds ratio: 2.4; 95% confidence interval: 1.25 to 4.59; p = 0.008). The rates of symptomatic intracerebral hemorrhage and 90-day mortality were comparable among all 4 treatment groups. CONCLUSIONS: Acute stenting of the extracranial ICA with antithrombotic therapy in combination with intracranial thrombectomy is associated with higher recanalization rates in treatment of patients with acute stroke with tandem lesions.
Authors: Christian N Ramsey; Charles B Newman; Michael R Jones; Anona Archer; Curtis A Given Journal: Interv Neuroradiol Date: 2019-07-16 Impact factor: 1.610
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