V Da Ros1, J Scaggiante2, F Sallustio3, S Lattanzi4, M Bandettini5, A Sgreccia6, C Rolla-Bigliani7, E Lafe6, G Sanfilippo6, M Diomedi3, M Ruggiero8, N Haznedari8, M Giannoni9, C Finocchi5, R Floris2. 1. From the Department of Biomedicine and Prevention (V.D.R., J.S., R.F.), Interventional Neuroradiology Unit darosvalerio@gmail.com. 2. From the Department of Biomedicine and Prevention (V.D.R., J.S., R.F.), Interventional Neuroradiology Unit. 3. Comprehensive Stroke Center (F.S., M.D.), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy. 4. Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy. 5. Neurological Clinic (M.B., C.F.). 6. Department of Neurosciences and Interventional Neuroradiology Unit (A.S., E.L., G.S.), IRCCS Policlinico San Matteo, Pavia, Italy. 7. Department of Diagnostic and Interventional Neuroradiology (C.R.-B.), Policlinico Universitario, San Martino, Italy. 8. Neuroradiology Unit (M.R., N.H.), AUSL Romagna, Cesena, Italy. 9. Neuroradiological Clinic (M.G.), Department of Radiological Sciences, AOU Ospedali Riuniti, Ancona, Italy.
Abstract
BACKGROUND AND PURPOSE: There is no consensus on the optimal antithrombotic medication for patients with acute ischemic stroke with anterior circulation tandem occlusions treated with emergent carotid stent placement and mechanical thrombectomy. The identification of factors influencing hemorrhagic risks can assist in creating appropriate therapeutic algorithms for such patients. This study aimed to investigate the impact of medical therapy on functional and safety outcomes in patients treated with carotid stent placement and mechanical thrombectomy for tandem occlusions. MATERIALS AND METHODS: A multicenter retrospective study on prospectively collected data was conducted. Only patients treated with carotid stent placement and mechanical thrombectomy for tandem occlusions of the anterior circulation were included. Univariate and multivariate analyses were performed on preprocedural, procedural, and postprocedural variables to assess factors influencing clinical outcome, symptomatic intracranial hemorrhage, stent patency, and successful intracranial vessel recanalization. RESULTS: Ninety-five patients with acute ischemic stroke and tandem occlusions were included. Good clinical outcome (mRS ≤ 2) at 3 months was reached by 33 (39.3%) patients and was associated with baseline ASPECTS ≥ 8 (OR = 1.53; 95% CI, 1.16-2.00), ≤2 mechanical thrombectomy attempts (OR = 0.71; 95% CI, 0.55-0.99), and the absence of symptomatic intracranial hemorrhage (OR = 0.13; 95% CI , 0.03-0.51). Symptomatic intracranial hemorrhage was associated with a higher amount of intraprocedural heparin, ASPECTS ≤ 7, and ≥3 mechanical thrombectomy attempts. No relationships among types of acute antiplatelet regimen, intravenous thrombolysis, and symptomatic intracranial hemorrhage were observed. Patients receiving dual-antiplatelet therapy after hemorrhagic transformation had been ruled out on 24-hour CT were more likely to achieve functional independence and had a lower risk of symptomatic intracranial hemorrhage. CONCLUSIONS: During carotid stent placement and mechanical thrombectomy for tandem occlusion treatment, higher intraprocedural heparin dosage (≥3000 IU) increased symptomatic intracranial hemorrhage risk when the initial ASPECTS was ≤7, and mechanical thrombectomy needs more than one passage for complete recanalization. Antiplatelets antiplatelets use were safe, and dual-antiaggregation therapy was related to better functional outcomes.
BACKGROUND AND PURPOSE: There is no consensus on the optimal antithrombotic medication for patients with acute ischemic stroke with anterior circulation tandem occlusions treated with emergent carotid stent placement and mechanical thrombectomy. The identification of factors influencing hemorrhagic risks can assist in creating appropriate therapeutic algorithms for such patients. This study aimed to investigate the impact of medical therapy on functional and safety outcomes in patients treated with carotid stent placement and mechanical thrombectomy for tandem occlusions. MATERIALS AND METHODS: A multicenter retrospective study on prospectively collected data was conducted. Only patients treated with carotid stent placement and mechanical thrombectomy for tandem occlusions of the anterior circulation were included. Univariate and multivariate analyses were performed on preprocedural, procedural, and postprocedural variables to assess factors influencing clinical outcome, symptomatic intracranial hemorrhage, stent patency, and successful intracranial vessel recanalization. RESULTS: Ninety-five patients with acute ischemic stroke and tandem occlusions were included. Good clinical outcome (mRS ≤ 2) at 3 months was reached by 33 (39.3%) patients and was associated with baseline ASPECTS ≥ 8 (OR = 1.53; 95% CI, 1.16-2.00), ≤2 mechanical thrombectomy attempts (OR = 0.71; 95% CI, 0.55-0.99), and the absence of symptomatic intracranial hemorrhage (OR = 0.13; 95% CI , 0.03-0.51). Symptomatic intracranial hemorrhage was associated with a higher amount of intraprocedural heparin, ASPECTS ≤ 7, and ≥3 mechanical thrombectomy attempts. No relationships among types of acute antiplatelet regimen, intravenous thrombolysis, and symptomatic intracranial hemorrhage were observed. Patients receiving dual-antiplatelet therapy after hemorrhagic transformation had been ruled out on 24-hour CT were more likely to achieve functional independence and had a lower risk of symptomatic intracranial hemorrhage. CONCLUSIONS: During carotid stent placement and mechanical thrombectomy for tandem occlusion treatment, higher intraprocedural heparin dosage (≥3000 IU) increased symptomatic intracranial hemorrhage risk when the initial ASPECTS was ≤7, and mechanical thrombectomy needs more than one passage for complete recanalization. Antiplatelets antiplatelets use were safe, and dual-antiaggregation therapy was related to better functional outcomes.
Authors: J T Lindsay Wilson; Asha Hareendran; Marie Grant; Tracey Baird; Ursula G R Schulz; Keith W Muir; Ian Bone Journal: Stroke Date: 2002-09 Impact factor: 7.914
Authors: J H Pexman; P A Barber; M D Hill; R J Sevick; A M Demchuk; M E Hudon; W Y Hu; A M Buchan Journal: AJNR Am J Neuroradiol Date: 2001-09 Impact factor: 3.825
Authors: Mohammad Anadani; Alejandro M. Spiotta; Ali Alawieh; Francis Turjman; Michel Piotin; Diogo C. Haussen; Raul G. Nogueira; Panagiotis Papanagiotou; Adnan H. Siddiqui; Bertrand Lapergue; Franziska Dorn; Christophe Cognard; Marc Ribo; Marios N. Psychogios; Marc Antoine Labeyrie; Mikael Mazighi; Alessandra Biondi; René Anxionnat; Serge Bracard; Sébastien Richard; Benjamin Gory Journal: Stroke Date: 2019-06-17 Impact factor: 7.914
Authors: Marta Rubiera; Marc Ribo; Raquel Delgado-Mederos; Esteban Santamarina; Pilar Delgado; Joan Montaner; José Alvarez-Sabín; Carlos A Molina Journal: Stroke Date: 2006-08-03 Impact factor: 7.914
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: Panagiotis Papanagiotou; Diogo C Haussen; Francis Turjman; Julien Labreuche; Michel Piotin; Andreas Kastrup; Henrik Steglich-Arnholm; Markus Holtmannspötter; Christian Taschner; Sebastian Eiden; Raul G Nogueira; Maria Boutchakova; Adnan Siddiqui; Bertrand Lapergue; Franziska Dorn; Christophe Cognard; Monika Killer; Salvatore Mangiafico; Marc Ribo; Marios N Psychogios; Alejandro Spiotta; Marc Antoine Labeyrie; Alessandra Biondi; Mikaël Mazighi; Sébastien Richard; René Anxionnat; Serge Bracard; Benjamin Gory Journal: JACC Cardiovasc Interv Date: 2018-07-09 Impact factor: 11.195
Authors: U Sadeh-Gonik; N Tau; T Friehmann; S Bracard; R Anxionnat; A-L Derelle; R Tonnelet; L Liao; S Richard; X Armoiry; B Gory Journal: Eur J Neurol Date: 2018-03-01 Impact factor: 6.089
Authors: Jeffrey L Saver; Mayank Goyal; Alain Bonafe; Hans-Christoph Diener; Elad I Levy; Vitor M Pereira; Gregory W Albers; Christophe Cognard; David J Cohen; Werner Hacke; Olav Jansen; Tudor G Jovin; Heinrich P Mattle; Raul G Nogueira; Adnan H Siddiqui; Dileep R Yavagal; Blaise W Baxter; Thomas G Devlin; Demetrius K Lopes; Vivek K Reddy; Richard du Mesnil de Rochemont; Oliver C Singer; Reza Jahan Journal: N Engl J Med Date: 2015-04-17 Impact factor: 91.245
Authors: Bruce C V Campbell; Peter J Mitchell; Timothy J Kleinig; Helen M Dewey; Leonid Churilov; Nawaf Yassi; Bernard Yan; Richard J Dowling; Mark W Parsons; Thomas J Oxley; Teddy Y Wu; Mark Brooks; Marion A Simpson; Ferdinand Miteff; Christopher R Levi; Martin Krause; Timothy J Harrington; Kenneth C Faulder; Brendan S Steinfort; Miriam Priglinger; Timothy Ang; Rebecca Scroop; P Alan Barber; Ben McGuinness; Tissa Wijeratne; Thanh G Phan; Winston Chong; Ronil V Chandra; Christopher F Bladin; Monica Badve; Henry Rice; Laetitia de Villiers; Henry Ma; Patricia M Desmond; Geoffrey A Donnan; Stephen M Davis Journal: N Engl J Med Date: 2015-02-11 Impact factor: 91.245