Mohammad Anadani1, Alejandro M. Spiotta1, Ali Alawieh1, Francis Turjman2, Michel Piotin3, Diogo C. Haussen4, Raul G. Nogueira4, Panagiotis Papanagiotou5, Adnan H. Siddiqui6, Bertrand Lapergue7, Franziska Dorn8, Christophe Cognard9, Marc Ribo10, Marios N. Psychogios11, Marc Antoine Labeyrie12, Mikael Mazighi13, Alessandra Biondi14, René Anxionnat15, Serge Bracard15, Sébastien Richard16, Benjamin Gory15. 1. From the Department of Neurosurgery, Medical University of South Carolina, Charleston (M.A., A.M.S., A.A.) 2. Department of Interventional Neuroradiology, Hospices Civils de Lyon, France (F.T.) 3. Department of Interventional Neuroradiology, Paris, France (M.P., M.M.) 4. Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta (R.G.N., D.C.H.) 5. Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte/Bremen-Ost, Deutschland (P.P.) 6. Department of Neurosurgery, State University of New York, Buffalo (A.H.S.) 7. Department of Neurology, Stroke Center, Foch Hospital, Suresnes, France (B.L.) 8. Department of Neuroradiology, University Hospital of Munich, Germany (F.D.) 9. Department of Neuroradiology, University Hospital of Toulouse, France (C.C.) 10. Department of Neurology, Hospital Vall D’Hebron, Barcelona, Spain (M.R.) 11. Department of Neuroradiology, University Medical Center Göttingen, Germany (M.P.) 12. Department of Interventional Neuroradiology, Lariboisière Hospital, Paris, France (M.A.L.) 13. Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (M.M.) 14. Department of Neuroradiology and Endovascular Therapeutic, University Hospital of Besançon, France (A.B.) 15. Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, INSERM U1254, France (R.A., S.B., B.G.) 16. Department of Neurology, Stroke Unit, University Hospital of Nancy, INSERM U1116, France (S.R.)
Abstract
Background and Purpose: Emergent carotid artery stenting plus mechanical thrombectomy is an effective treatment for acute ischemic stroke patients with tandem occlusion of the anterior circulation. However, there is limited data supporting the safety of this approach in patients treated with prior intravenous thrombolysis (IVT). We aimed to investigate the safety of emergent carotid artery stenting-mechanical thrombectomy approach in stroke patient population treated with prior IVT Methods: —We assessed patients with acute ischemic stroke because of atherosclerotic tandem occlusion that were treated with emergent carotid artery stenting-mechanical thrombectomy approach from the multicenter observational Thrombectomy in Tandem Lesions registry. Patients were divided into 2 groups based on pretreatment IVT (IVT versus no-IVT). Intracerebral hemorrhages were classified according to the European Cooperative Acute Stroke Study II criteria. Results: Among 205 patients included in the present study, 125 (60%) received prior IVT. Time from symptoms onsetto-groin puncture was shorter (234±100 versus 256±234 minutes; P=0.002), and heparin use was less in the IVT group (14% versus 35%; P<0.001); otherwise, there was no difference in the baseline characteristics. There was no significant difference between the IVT and no-IVT groups in the rate of symptomatic intracerebral hemorrhage (5% versus 8%; P=0.544), parenchymal hematoma type 1 to 2 (15% versus 18%; P=0.647), successful reperfusion (modified Thrombolysis in Cerebral Ischemia 2b–3), or 90-day favorable outcome (modified Rankin Scale score of 0–2 at 90 days). The 90-day all-cause mortality rate was significantly lower in the IVT group (8% versus 20%; P=0.017). After adjusting for covariates, IVT was not associated with symptomatic intracerebral hemorrhage or 90-day mortality Conclusions: Emergent carotid artery stenting-mechanical thrombectomy approach was not associated with an increased risk of hemorrhagic complications in tandem occlusion patients who received IVT before the intervention.
Background and Purpose: Emergent carotid artery stenting plus mechanical thrombectomy is an effective treatment for acute ischemic strokepatients with tandem occlusion of the anterior circulation. However, there is limited data supporting the safety of this approach in patients treated with prior intravenous thrombolysis (IVT). We aimed to investigate the safety of emergent carotid artery stenting-mechanical thrombectomy approach in strokepatient population treated with prior IVT Methods: —We assessed patients with acute ischemic stroke because of atherosclerotic tandem occlusion that were treated with emergent carotid artery stenting-mechanical thrombectomy approach from the multicenter observational Thrombectomy in Tandem Lesions registry. Patients were divided into 2 groups based on pretreatment IVT (IVT versus no-IVT). Intracerebral hemorrhages were classified according to the European Cooperative Acute Stroke Study II criteria. Results: Among 205 patients included in the present study, 125 (60%) received prior IVT. Time from symptoms onsetto-groin puncture was shorter (234±100 versus 256±234 minutes; P=0.002), and heparin use was less in the IVT group (14% versus 35%; P<0.001); otherwise, there was no difference in the baseline characteristics. There was no significant difference between the IVT and no-IVT groups in the rate of symptomatic intracerebral hemorrhage (5% versus 8%; P=0.544), parenchymal hematoma type 1 to 2 (15% versus 18%; P=0.647), successful reperfusion (modified Thrombolysis in Cerebral Ischemia 2b–3), or 90-day favorable outcome (modified Rankin Scale score of 0–2 at 90 days). The 90-day all-cause mortality rate was significantly lower in the IVT group (8% versus 20%; P=0.017). After adjusting for covariates, IVT was not associated with symptomatic intracerebral hemorrhage or 90-day mortality Conclusions: Emergent carotid artery stenting-mechanical thrombectomy approach was not associated with an increased risk of hemorrhagic complications in tandem occlusionpatients who received IVT before the intervention.
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: Xiaoli Min; Jianhua Du; Xuesong Bai; Tao Wei; Adam A Dmytriw; Aman B Patel; Xiao Zhang; Xin Xu; Yao Feng; Tao Wang; Xue Wang; Kun Yang; Weiwu Hu; Tingyu Yi; Wenhuo Chen; Liqun Jiao Journal: Front Neurol Date: 2022-01-12 Impact factor: 4.003