Thrombectomy in Acute Stroke With Tandem Occlusions From Dissection Versus Atherosclerotic Cause

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; Franziska Dorn; Christophe Cognard; Monika Killer-Oberpfalzer; Salvatore Mangiafico; Marc Ribo; Daniel Behme; Alejandro M Spiotta; Mikael Mazighi; Francis Turjman; TITAN Investigators

doi:10.1161/STROKEAHA.117.018264

Thrombectomy in Acute Stroke With Tandem Occlusions From Dissection Versus Atherosclerotic Cause

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, Franziska Dorn, Christophe Cognard, Monika Killer-Oberpfalzer, Salvatore Mangiafico, Marc Ribo, Daniel Behme, Alejandro M Spiotta, Mikael MazighiFrancis Turjman, TITAN Investigators

69 Citationer (Scopus)

Abstract

BACKGROUND AND PURPOSE: Tandem steno-occlusive lesions were poorly represented in randomized trials and represent a major challenge for endovascular thrombectomy in acute anterior circulation strokes. The impact of the cervical carotid lesion cause (ie, atherosclerotic versus dissection) on outcome of tandem patients endovascularly treated remains to be assessed.

METHODS: We retrospectively analyzed individual data of prospectively collected consecutive tandem patients treated with endovascular thrombectomy. The primary outcome was favorable outcome at 90 days (modified Rankin Scale score of 0-2). Secondary efficacy outcomes included successful reperfusion (modified Thrombolysis in Cerebrovascular Infarction scores of 2b-3), time to reperfusion, and safety outcomes encompassed procedural complications, symptomatic intracerebral hemorrhage, and 90-day mortality.

RESULTS: Among the 295 included patients, 65 had cervical carotid dissection and 230 had cervical carotid atherosclerotic cause. The rate of favorable outcome was 56.3% in the dissection group versus 47.6% in the atherosclerotic arm (center-, age-, and admission National Institutes of Health Stroke Scale-adjusted odds ratio, 1.08; 95% confidence interval, 0.50-2.30; P=0.85). No significant differences were observed in secondary outcomes. The rates of successful reperfusion, symptomatic intracerebral hemorrhage, and 90-day mortality were 78.5% versus 74.5% (P=0.13), 4.6% versus 5.2% (P=1.0), and 7.8% versus 15.3% (P=0.94) in the dissection versus atherosclerotic groups, respectively. The median procedural time was 76 minutes (interquartile range, 52-95 minutes) in the dissection group and 67 minutes (interquartile range, 45-98 minutes) in the atherosclerotic group (P=0.24).

CONCLUSIONS: We found no differences in the outcomes of patients with anterior circulation tandem atherosclerotic and dissection lesions treated with endovascular thrombectomy. Further studies are warranted.

Originalsprog	Engelsk
Tidsskrift	Stroke
Vol/bind	48
Udgave nummer	11
Sider (fra-til)	3145-3148
Antal sider	4
ISSN	0039-2499
DOI	https://doi.org/10.1161/STROKEAHA.117.018264
Status	Udgivet - nov. 2017

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10.1161/STROKEAHA.117.018264

Citationsformater

Gory, B., Piotin, M., Haussen, D. C., Steglich-Arnholm, H., Holtmannspötter, M., Labreuche, J., Taschner, C., Eiden, S., Nogueira, R. G., Papanagiotou, P., Boutchakova, M., Siddiqui, A., Dorn, F., Cognard, C., Killer-Oberpfalzer, M., Mangiafico, S., Ribo, M., Behme, D., Spiotta, A. M., ... TITAN Investigators (2017). Thrombectomy in Acute Stroke With Tandem Occlusions From Dissection Versus Atherosclerotic Cause. Stroke, 48(11), 3145-3148. https://doi.org/10.1161/STROKEAHA.117.018264

Gory, B, Piotin, M, Haussen, DC, Steglich-Arnholm, H, Holtmannspötter, M, Labreuche, J, Taschner, C, Eiden, S, Nogueira, RG, Papanagiotou, P, Boutchakova, M, Siddiqui, A, Dorn, F, Cognard, C, Killer-Oberpfalzer, M, Mangiafico, S, Ribo, M, Behme, D, Spiotta, AM, Mazighi, M, Turjman, F & TITAN Investigators 2017, 'Thrombectomy in Acute Stroke With Tandem Occlusions From Dissection Versus Atherosclerotic Cause', Stroke, bind 48, nr. 11, s. 3145-3148. https://doi.org/10.1161/STROKEAHA.117.018264

@article{a9d914ea6fec4591925fe38026d08d03,

title = "Thrombectomy in Acute Stroke With Tandem Occlusions From Dissection Versus Atherosclerotic Cause",

abstract = "BACKGROUND AND PURPOSE: Tandem steno-occlusive lesions were poorly represented in randomized trials and represent a major challenge for endovascular thrombectomy in acute anterior circulation strokes. The impact of the cervical carotid lesion cause (ie, atherosclerotic versus dissection) on outcome of tandem patients endovascularly treated remains to be assessed.METHODS: We retrospectively analyzed individual data of prospectively collected consecutive tandem patients treated with endovascular thrombectomy. The primary outcome was favorable outcome at 90 days (modified Rankin Scale score of 0-2). Secondary efficacy outcomes included successful reperfusion (modified Thrombolysis in Cerebrovascular Infarction scores of 2b-3), time to reperfusion, and safety outcomes encompassed procedural complications, symptomatic intracerebral hemorrhage, and 90-day mortality.RESULTS: Among the 295 included patients, 65 had cervical carotid dissection and 230 had cervical carotid atherosclerotic cause. The rate of favorable outcome was 56.3% in the dissection group versus 47.6% in the atherosclerotic arm (center-, age-, and admission National Institutes of Health Stroke Scale-adjusted odds ratio, 1.08; 95% confidence interval, 0.50-2.30; P=0.85). No significant differences were observed in secondary outcomes. The rates of successful reperfusion, symptomatic intracerebral hemorrhage, and 90-day mortality were 78.5% versus 74.5% (P=0.13), 4.6% versus 5.2% (P=1.0), and 7.8% versus 15.3% (P=0.94) in the dissection versus atherosclerotic groups, respectively. The median procedural time was 76 minutes (interquartile range, 52-95 minutes) in the dissection group and 67 minutes (interquartile range, 45-98 minutes) in the atherosclerotic group (P=0.24).CONCLUSIONS: We found no differences in the outcomes of patients with anterior circulation tandem atherosclerotic and dissection lesions treated with endovascular thrombectomy. Further studies are warranted.",

keywords = "Acute Disease, Aged, Brain Infarction, Carotid Artery, Internal, Dissection, Cerebral Hemorrhage, Endovascular Procedures, Humans, Intracranial Arteriosclerosis, Middle Aged, Retrospective Studies, Stroke, Thrombectomy, Time Factors, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial",

author = "Benjamin Gory and Michel Piotin and Haussen, {Diogo C} and Henrik Steglich-Arnholm and Markus Holtmannsp{\"o}tter and Julien Labreuche and Christian Taschner and Sebastian Eiden and Nogueira, {Raul G} and Panagiotis Papanagiotou and Maria Boutchakova and Adnan Siddiqui and Franziska Dorn and Christophe Cognard and Monika Killer-Oberpfalzer and Salvatore Mangiafico and Marc Ribo and Daniel Behme and Spiotta, {Alejandro M} and Mikael Mazighi and Francis Turjman and {TITAN Investigators}",

note = "{\textcopyright} 2017 American Heart Association, Inc.",

year = "2017",

month = nov,

doi = "10.1161/STROKEAHA.117.018264",

language = "English",

volume = "48",

pages = "3145--3148",

journal = "Stroke",

issn = "0039-2499",

publisher = "Wolters Kluwer Health",

number = "11",

}

TY - JOUR

T1 - Thrombectomy in Acute Stroke With Tandem Occlusions From Dissection Versus Atherosclerotic Cause

AU - Gory, Benjamin

AU - Piotin, Michel

AU - Haussen, Diogo C

AU - Steglich-Arnholm, Henrik

AU - Holtmannspötter, Markus

AU - Labreuche, Julien

AU - Taschner, Christian

AU - Eiden, Sebastian

AU - Nogueira, Raul G

AU - Papanagiotou, Panagiotis

AU - Boutchakova, Maria

AU - Siddiqui, Adnan

AU - Dorn, Franziska

AU - Cognard, Christophe

AU - Killer-Oberpfalzer, Monika

AU - Mangiafico, Salvatore

AU - Ribo, Marc

AU - Behme, Daniel

AU - Spiotta, Alejandro M

AU - Mazighi, Mikael

AU - Turjman, Francis

AU - TITAN Investigators

PY - 2017/11

Y1 - 2017/11

N2 - BACKGROUND AND PURPOSE: Tandem steno-occlusive lesions were poorly represented in randomized trials and represent a major challenge for endovascular thrombectomy in acute anterior circulation strokes. The impact of the cervical carotid lesion cause (ie, atherosclerotic versus dissection) on outcome of tandem patients endovascularly treated remains to be assessed.METHODS: We retrospectively analyzed individual data of prospectively collected consecutive tandem patients treated with endovascular thrombectomy. The primary outcome was favorable outcome at 90 days (modified Rankin Scale score of 0-2). Secondary efficacy outcomes included successful reperfusion (modified Thrombolysis in Cerebrovascular Infarction scores of 2b-3), time to reperfusion, and safety outcomes encompassed procedural complications, symptomatic intracerebral hemorrhage, and 90-day mortality.RESULTS: Among the 295 included patients, 65 had cervical carotid dissection and 230 had cervical carotid atherosclerotic cause. The rate of favorable outcome was 56.3% in the dissection group versus 47.6% in the atherosclerotic arm (center-, age-, and admission National Institutes of Health Stroke Scale-adjusted odds ratio, 1.08; 95% confidence interval, 0.50-2.30; P=0.85). No significant differences were observed in secondary outcomes. The rates of successful reperfusion, symptomatic intracerebral hemorrhage, and 90-day mortality were 78.5% versus 74.5% (P=0.13), 4.6% versus 5.2% (P=1.0), and 7.8% versus 15.3% (P=0.94) in the dissection versus atherosclerotic groups, respectively. The median procedural time was 76 minutes (interquartile range, 52-95 minutes) in the dissection group and 67 minutes (interquartile range, 45-98 minutes) in the atherosclerotic group (P=0.24).CONCLUSIONS: We found no differences in the outcomes of patients with anterior circulation tandem atherosclerotic and dissection lesions treated with endovascular thrombectomy. Further studies are warranted.

AB - BACKGROUND AND PURPOSE: Tandem steno-occlusive lesions were poorly represented in randomized trials and represent a major challenge for endovascular thrombectomy in acute anterior circulation strokes. The impact of the cervical carotid lesion cause (ie, atherosclerotic versus dissection) on outcome of tandem patients endovascularly treated remains to be assessed.METHODS: We retrospectively analyzed individual data of prospectively collected consecutive tandem patients treated with endovascular thrombectomy. The primary outcome was favorable outcome at 90 days (modified Rankin Scale score of 0-2). Secondary efficacy outcomes included successful reperfusion (modified Thrombolysis in Cerebrovascular Infarction scores of 2b-3), time to reperfusion, and safety outcomes encompassed procedural complications, symptomatic intracerebral hemorrhage, and 90-day mortality.RESULTS: Among the 295 included patients, 65 had cervical carotid dissection and 230 had cervical carotid atherosclerotic cause. The rate of favorable outcome was 56.3% in the dissection group versus 47.6% in the atherosclerotic arm (center-, age-, and admission National Institutes of Health Stroke Scale-adjusted odds ratio, 1.08; 95% confidence interval, 0.50-2.30; P=0.85). No significant differences were observed in secondary outcomes. The rates of successful reperfusion, symptomatic intracerebral hemorrhage, and 90-day mortality were 78.5% versus 74.5% (P=0.13), 4.6% versus 5.2% (P=1.0), and 7.8% versus 15.3% (P=0.94) in the dissection versus atherosclerotic groups, respectively. The median procedural time was 76 minutes (interquartile range, 52-95 minutes) in the dissection group and 67 minutes (interquartile range, 45-98 minutes) in the atherosclerotic group (P=0.24).CONCLUSIONS: We found no differences in the outcomes of patients with anterior circulation tandem atherosclerotic and dissection lesions treated with endovascular thrombectomy. Further studies are warranted.

KW - Acute Disease

KW - Aged

KW - Brain Infarction

KW - Carotid Artery, Internal, Dissection

KW - Cerebral Hemorrhage

KW - Endovascular Procedures

KW - Humans

KW - Intracranial Arteriosclerosis

KW - Middle Aged

KW - Retrospective Studies

KW - Stroke

KW - Thrombectomy

KW - Time Factors

KW - Comparative Study

KW - Journal Article

KW - Multicenter Study

KW - Randomized Controlled Trial

U2 - 10.1161/STROKEAHA.117.018264

DO - 10.1161/STROKEAHA.117.018264

M3 - Journal article

C2 - 28974628

SN - 0039-2499

VL - 48

SP - 3145

EP - 3148

JO - Stroke

JF - Stroke

IS - 11

ER -

Thrombectomy in Acute Stroke With Tandem Occlusions From Dissection Versus Atherosclerotic Cause

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