François Zhu1,2, Michel Piotin3, Henrik Steglich-Arnholm4, Julien Labreuche5, Markus Holtmannspötter6, Christian Taschner7, Sebastian Eiden7, Diogo C Haussen8, Raul G Nogueira8, Panagiotis Papanagiotou9, Maria Boutchakova9, Adnan H Siddiqui10, Bertrand Lapergue11, Franziska Dorn12, Christophe Cognard13, Monika Killer-Oberpfalzer14, Salvatore Mangiafico15, Marc Ribo16, Marios N Psychogios17, Alejandro Spiotta18, Mohammad Anadani18, Marc-Antoine Labeyrie19, Mikael Mazighi3, Alessandra Biondi20, Sébastien Richard21, René Anxionnat22, Serge Bracard22, Francis Turjman23, Benjamin Gory22. 1. Department of Diagnostic and Therapeutic Neuroradiology, IADI INSERM U1254, University Hospital of Nancy, Nancy, France. f.zhu@chru-nancy.fr. 2. Department of Diagnostic and Therapeutic Neuroradiology, CHRU Nancy, Hôpital Central, 29 Avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, France. f.zhu@chru-nancy.fr. 3. Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France. 4. Department of Neurology, Rigshospitalet, Copenhagen, Denmark. 5. EA 2694-Santé Publique: Epidémiologie et Qualité des Soins, Department of Biostatistics, CHU Lille, University of Lille, Lille, France. 6. Department of Neuroradiology, Rigshospitalet, Copenhagen, Denmark. 7. Department of Neuroradiology, Medical Center, University of Freiburg, Freiburg, Germany. 8. Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta, Georgia. 9. Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte/Bremen-Ost, Bremen, Germany. 10. Department of Neurosurgery, State University of New York, Buffalo, USA. 11. Department of Neurology, Stroke Center, Foch Hospital, Suresnes, France. 12. Department of Neuroradiology, University Hospital of Munich, Munich, Germany. 13. Department of Neuroradiology, University Hospital of Toulouse, Toulouse, France. 14. Department of Neurology, Paracelsus Medical University Salzburg, Salzburg, Austria. 15. Department of Interventional Neuroradiology, Careggi University Hospital, Florence, Italy. 16. Department of Neurology, Hospital Vall D'Hebron, Barcelona, Spain. 17. Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany. 18. Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA. 19. Department of Interventional Neuroradiology, Lariboisière Hospital, Paris, France. 20. Department of Neuroradiology and Endovascular Therapeutic, University Hospital of Besançon, Besançon, France. 21. Department of Neurology Stroke Unit, INSERM U1116, University Hospital of Nancy, Nancy, France. 22. Department of Diagnostic and Therapeutic Neuroradiology, IADI INSERM U1254, University Hospital of Nancy, Nancy, France. 23. Department of Interventional Neuroradiology, Hospices Civils de Lyon, Lyon, France.
Abstract
BACKGROUND AND PURPOSE: Data on safety and efficacy of periprocedural use of heparin are limited during treatment of acute ischemic stroke patients with anterior circulation tandem occlusion. This study aimed to investigate the impact of heparin use during endovascular therapy of anterior circulation tandem occlusions on the functional and safety outcomes. METHODS: A retrospective analysis of the multicenter observational TITAN registry was performed. Patients with anterior circulation tandem occlusion and treated with endovascular therapy (EVT) were included, with or without extracranial carotid intervention. We divided patients into two groups based on periprocedural heparin use (heparin vs. non-heparin). The dose of intravenous unfractionated heparin ranged from 1500 to 2500 I.U. Primary study endpoint was 90-day Modified Rankin Scale (mRS). Secondary study endpoint included angiographic and safety endpoints such as hemorrhagic complications. A propensity-score-matched analysis was performed. RESULTS: Among 369 patients, heparin was used in 68 patients (18.4%). In the propensity-score-matched cohort, favorable outcome (mRS 0-2) occurred in 51.3% in heparin group and 58.0% in non-heparin group (matched OR, 0.76; 95% CI, 0.32-1.78; P = 0.52). Similar result was found in propensity-score-adjusted cohort (adjusted OR, 0.72; 95%CI, 0.39-1.32; P = 0.28). Likewise, there was no difference in the rate of successful reperfusion (mTICI 2b-3) (propensity-score-adjusted OR, 1.03; 95%CI, 0.50-2.09; P = 0.93) neither in safety endpoints between the two groups. CONCLUSIONS: Periprocedural heparin use during EVT of anterior circulation tandem occlusions was not associated with better functional, angiographic or safety outcomes. These findings are applicable for low doses of heparin, and further studies are warranted.
BACKGROUND AND PURPOSE: Data on safety and efficacy of periprocedural use of heparin are limited during treatment of acute ischemic strokepatients with anterior circulation tandem occlusion. This study aimed to investigate the impact of heparin use during endovascular therapy of anterior circulation tandem occlusions on the functional and safety outcomes. METHODS: A retrospective analysis of the multicenter observational TITAN registry was performed. Patients with anterior circulation tandem occlusion and treated with endovascular therapy (EVT) were included, with or without extracranial carotid intervention. We divided patients into two groups based on periprocedural heparin use (heparin vs. non-heparin). The dose of intravenous unfractionated heparin ranged from 1500 to 2500 I.U. Primary study endpoint was 90-day Modified Rankin Scale (mRS). Secondary study endpoint included angiographic and safety endpoints such as hemorrhagic complications. A propensity-score-matched analysis was performed. RESULTS: Among 369 patients, heparin was used in 68 patients (18.4%). In the propensity-score-matched cohort, favorable outcome (mRS 0-2) occurred in 51.3% in heparin group and 58.0% in non-heparin group (matched OR, 0.76; 95% CI, 0.32-1.78; P = 0.52). Similar result was found in propensity-score-adjusted cohort (adjusted OR, 0.72; 95%CI, 0.39-1.32; P = 0.28). Likewise, there was no difference in the rate of successful reperfusion (mTICI 2b-3) (propensity-score-adjusted OR, 1.03; 95%CI, 0.50-2.09; P = 0.93) neither in safety endpoints between the two groups. CONCLUSIONS: Periprocedural heparin use during EVT of anterior circulation tandem occlusions was not associated with better functional, angiographic or safety outcomes. These findings are applicable for low doses of heparin, and further studies are warranted.
Entities:
Keywords:
Anticoagulation; Endovascular Treatment; Heparin; Stroke; Tandem occlusion; Thrombectomy
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