Diogo C Haussen1, Francis Turjman2, Michel Piotin3, Julien Labreuche4, Henrik Steglich-Arnholm5, Markus Holtmannspötter6, Christian Taschner7, Sebastian Eiden7, Raul G Nogueira1, Panagiotis Papanagiotou8, Maria Boutchakova8, Adnan H Siddiqui9, Bertrand Lapergue10, Franziska Dorn11, Christophe Cognard12, Monika Killer13, Salvatore Mangiafico14, Marc Ribo15, Marios N Psychogios16, Alejandro M Spiotta17, Marc-Antoine Labeyrie18, Mikael Mazighi3,19,20, Alessandra Biondi21, Sébastien Richard22,23, Jonathan A Grossberg1, René Anxionnat24,25, Serge Bracard24,25, Benjamin Gory24,25. 1. Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta, Georgia, USA. 2. Department of Interventional Neuroradiology, Hospices Civils, Lyon, France. 3. Department of Interventional Neuroradiology, Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild, Paris, France. 4. Department of Biostatistics, University of Lille, CHU Lille, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille, France. 5. Department of Neurology, Rigshospitalet, Copenhagen, Denmark. 6. Department of Neuroradiology, Rigshospitalet, Copenhagen, Denmark. 7. Department of Neuroradiology, Medical Center, University of Freiburg, Freiburg, Germany. 8. Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte/Bremen-Ost, Bremen, Germany. 9. Department of Neurosurgery, State University of New York, Buffalo, New York, 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, Paracelsus Medical University Salzburg, 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, South Carolina, USA. 18. Department of Interventional Neuroradiology, Lariboisière Hospital, Paris, France. 19. INSERM U1148, Paris, France. 20. Paris Denis Diderot University, Paris, France. 21. Department of Neuroradiology and Endovascular Therapeutic, University Hospital of Besançon, Besançon, France. 22. Stroke Unit, Department of Neurology, University Hospital of Nancy, Nancy, France. 23. Centre d'Investigation Clinique Plurithématique, INSERM U1116, Nancy, France. 24. Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France. 25. University of Lorraine, INSERM U1254, Nancy, France.
Abstract
BACKGROUND: We aim to evaluate the speed and rates of reperfusion in tandem large vessel occlusion acute stroke patients undergoing upfront cervical lesion treatment (Neck-First: angioplasty and/or stent before thrombectomy) as compared to direct intracranial occlusion therapy (Head-First) in a large international multicenter cohort. METHODS: The Thrombectomy In TANdem Lesions (TITAN) collaboration pooled individual data of prospectively collected thrombectomy international databases for all consecutive anterior circulation tandem patients who underwent emergent thrombectomy. The co-primary outcome measures were rates of successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b/3) and time from groin puncture to successful reperfusion. RESULTS: In total, 289 patients with tandem atherosclerotic etiology were included in the analysis (182 Neck-First and 107 Head-First patients). Except for differences in the Alberta Stroke Program Early CT Score (ASPECTS; median 8 [range 7-10] Neck-First vs. 7 [range 6-8] Head-First; p < 0.001) and cervical internal carotid artery (ICA) lesion severity (complete occlusion in 35% of the Neck-First vs. 57% of the Head-First patients; p < 0.001), patient characteristics were well balanced. After adjustments, there was no difference in successful reperfusion rates between the study groups (odds ratio associated with Neck-First: 1.18 [95% confidence interval, 0.60-2.17]). The time to successful reperfusion from groin puncture was significantly shorter in the Head-First group after adjustments (median 56 min [range 39-90] vs. 70 [range 50-102]; p = 0.001). No significant differences in the rates of full reperfusion, symptomatic hemorrhage, 90-day independence, or mortality were observed. Sensitivity analysis excluding patients with complete cervical ICA occlusion yielded similar results. CONCLUSIONS: The upfront approach of the intracranial lesion in patients with tandem large vessel occlusion strokes leads to similar reperfusion rates but faster reperfusion as compared to initial cervical revascularization followed by mechanical thrombectomy. Controlled studies are warranted.
BACKGROUND: We aim to evaluate the speed and rates of reperfusion in tandem large vessel occlusion acute stroke patients undergoing upfront cervical lesion treatment (Neck-First: angioplasty and/or stent before thrombectomy) as compared to direct intracranial occlusion therapy (Head-First) in a large international multicenter cohort. METHODS: The Thrombectomy In TANdem Lesions (TITAN) collaboration pooled individual data of prospectively collected thrombectomy international databases for all consecutive anterior circulation tandem patients who underwent emergent thrombectomy. The co-primary outcome measures were rates of successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b/3) and time from groin puncture to successful reperfusion. RESULTS: In total, 289 patients with tandem atherosclerotic etiology were included in the analysis (182 Neck-First and 107 Head-First patients). Except for differences in the Alberta Stroke Program Early CT Score (ASPECTS; median 8 [range 7-10] Neck-First vs. 7 [range 6-8] Head-First; p < 0.001) and cervical internal carotid artery (ICA) lesion severity (complete occlusion in 35% of the Neck-First vs. 57% of the Head-First patients; p < 0.001), patient characteristics were well balanced. After adjustments, there was no difference in successful reperfusion rates between the study groups (odds ratio associated with Neck-First: 1.18 [95% confidence interval, 0.60-2.17]). The time to successful reperfusion from groin puncture was significantly shorter in the Head-First group after adjustments (median 56 min [range 39-90] vs. 70 [range 50-102]; p = 0.001). No significant differences in the rates of full reperfusion, symptomatic hemorrhage, 90-day independence, or mortality were observed. Sensitivity analysis excluding patients with complete cervical ICA occlusion yielded similar results. CONCLUSIONS: The upfront approach of the intracranial lesion in patients with tandem large vessel occlusion strokes leads to similar reperfusion rates but faster reperfusion as compared to initial cervical revascularization followed by mechanical thrombectomy. Controlled studies are warranted.
Authors: Volker Maus; Jan Borggrefe; Daniel Behme; Christoph Kabbasch; Nuran Abdullayev; Utako Birgit Barnikol; Leonard Leong Litt Yeo; Patrick A Brouwer; Michael Söderman; Markus Möhlenbruch; Thomas Liebig; Gereon Rudolf Fink; Anastasios Mpotsaris Journal: Cerebrovasc Dis Date: 2018-08-09 Impact factor: 2.762
Authors: B Gory; D C Haussen; M Piotin; H Steglich-Arnholm; M Holtmannspötter; J Labreuche; M Kyheng; C Taschner; S Eiden; R G Nogueira; P Papanagiotou; M Boutchakova; A H Siddiqui; B Lapergue; F Dorn; C Cognard; M Killer; S Mangiafico; M Ribo; M N Psychogios; A M Spiotta; M A Labeyrie; A Biondi; M Mazighi; F Turjman Journal: Eur J Neurol Date: 2018-04-16 Impact factor: 6.089
Authors: Leonardo Rangel-Castilla; Gary B Rajah; Hakeem J Shakir; Hussain Shallwani; Sirin Gandhi; Jason M Davies; Kenneth V Snyder; Elad I Levy; Adnan H Siddiqui Journal: Neurosurg Focus Date: 2017-04 Impact factor: 4.047
Authors: Mitchell P Wilson; Mohammad H Murad; Timo Krings; Vitor M Pereira; Cian O'Kelly; Jeremy Rempel; Christopher A Hilditch; Waleed Brinjikji Journal: J Neurointerv Surg Date: 2018-03-09 Impact factor: 5.836
Authors: David S Liebeskind; Reza Jahan; Raul G Nogueira; Tudor G Jovin; Helmi L Lutsep; Jeffrey L Saver Journal: J Neurointerv Surg Date: 2015-05-11 Impact factor: 5.836
Authors: Mayank Goyal; Bijoy K Menon; Wim H van Zwam; Diederik W J Dippel; Peter J Mitchell; Andrew M Demchuk; Antoni Dávalos; Charles B L M Majoie; Aad van der Lugt; Maria A de Miquel; Geoffrey A Donnan; Yvo B W E M Roos; Alain Bonafe; Reza Jahan; Hans-Christoph Diener; Lucie A van den Berg; Elad I Levy; Olvert A Berkhemer; Vitor M Pereira; Jeremy Rempel; Mònica Millán; Stephen M Davis; Daniel Roy; John Thornton; Luis San Román; Marc Ribó; Debbie Beumer; Bruce Stouch; Scott Brown; Bruce C V Campbell; Robert J van Oostenbrugge; Jeffrey L Saver; Michael D Hill; Tudor G Jovin Journal: Lancet Date: 2016-02-18 Impact factor: 79.321
Authors: Tudor G Jovin; Angel Chamorro; Erik Cobo; María A de Miquel; Carlos A Molina; Alex Rovira; Luis San Román; Joaquín Serena; Sonia Abilleira; Marc Ribó; Mònica Millán; Xabier Urra; Pere Cardona; Elena López-Cancio; Alejandro Tomasello; Carlos Castaño; Jordi Blasco; Lucía Aja; Laura Dorado; Helena Quesada; Marta Rubiera; María Hernandez-Pérez; Mayank Goyal; Andrew M Demchuk; Rüdiger von Kummer; Miquel Gallofré; Antoni Dávalos Journal: N Engl J Med Date: 2015-04-17 Impact factor: 91.245
Authors: Olvert A Berkhemer; Puck S S Fransen; Debbie Beumer; Lucie A van den Berg; Hester F Lingsma; Albert J Yoo; Wouter J Schonewille; Jan Albert Vos; Paul J Nederkoorn; Marieke J H Wermer; Marianne A A van Walderveen; Julie Staals; Jeannette Hofmeijer; Jacques A van Oostayen; Geert J Lycklama à Nijeholt; Jelis Boiten; Patrick A Brouwer; Bart J Emmer; Sebastiaan F de Bruijn; Lukas C van Dijk; L Jaap Kappelle; Rob H Lo; Ewoud J van Dijk; Joost de Vries; Paul L M de Kort; Willem Jan J van Rooij; Jan S P van den Berg; Boudewijn A A M van Hasselt; Leo A M Aerden; René J Dallinga; Marieke C Visser; Joseph C J Bot; Patrick C Vroomen; Omid Eshghi; Tobien H C M L Schreuder; Roel J J Heijboer; Koos Keizer; Alexander V Tielbeek; Heleen M den Hertog; Dick G Gerrits; Renske M van den Berg-Vos; Giorgos B Karas; Ewout W Steyerberg; H Zwenneke Flach; Henk A Marquering; Marieke E S Sprengers; Sjoerd F M Jenniskens; Ludo F M Beenen; René van den Berg; Peter J Koudstaal; Wim H van Zwam; Yvo B W E M Roos; Aad van der Lugt; Robert J van Oostenbrugge; Charles B L M Majoie; Diederik W J Dippel Journal: N Engl J Med Date: 2014-12-17 Impact factor: 91.245
Authors: Mayank Goyal; Andrew M Demchuk; Bijoy K Menon; Muneer Eesa; Jeremy L Rempel; John Thornton; Daniel Roy; Tudor G Jovin; Robert A Willinsky; Biggya L Sapkota; Dar Dowlatshahi; Donald F Frei; Noreen R Kamal; Walter J Montanera; Alexandre Y Poppe; Karla J Ryckborst; Frank L Silver; Ashfaq Shuaib; Donatella Tampieri; David Williams; Oh Young Bang; Blaise W Baxter; Paul A Burns; Hana Choe; Ji-Hoe Heo; Christine A Holmstedt; Brian Jankowitz; Michael Kelly; Guillermo Linares; Jennifer L Mandzia; Jai Shankar; Sung-Il Sohn; Richard H Swartz; Philip A Barber; Shelagh B Coutts; Eric E Smith; William F Morrish; Alain Weill; Suresh Subramaniam; Alim P Mitha; John H Wong; Mark W Lowerison; Tolulope T Sajobi; Michael D Hill Journal: N Engl J Med Date: 2015-02-11 Impact factor: 91.245
Authors: Benjamin Gory; Michel Piotin; Diogo C Haussen; Henrik Steglich-Arnholm; Markus Holtmannspötter; Julien Labreuche; Christian Taschner; Sebastian Eiden; Raul G Nogueira; Panagiotis Papanagiotou; Maria Boutchakova; Adnan Siddiqui; Bertrand Lapergue; Franziska Dorn; Christophe Cognard; Monika Killer-Oberpfalzer; Salvatore Mangiafico; Marc Ribo; Daniel Behme; Alejandro M Spiotta; Mikael Mazighi; Francis Turjman Journal: Stroke Date: 2017-10-03 Impact factor: 7.914
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