TY - JOUR
T1 - Periprocedural Heparin During Endovascular Treatment of Tandem Lesions in Patients with Acute Ischemic Stroke
T2 - A Propensity Score Analysis from TITAN Registry
AU - Zhu, François
AU - Piotin, Michel
AU - Steglich-Arnholm, Henrik
AU - Labreuche, Julien
AU - Holtmannspötter, Markus
AU - Taschner, Christian
AU - Eiden, Sebastian
AU - Haussen, Diogo C
AU - Nogueira, Raul G
AU - Papanagiotou, Panagiotis
AU - Boutchakova, Maria
AU - Siddiqui, Adnan H
AU - Lapergue, Bertrand
AU - Dorn, Franziska
AU - Cognard, Christophe
AU - Killer-Oberpfalzer, Monika
AU - Mangiafico, Salvatore
AU - Ribo, Marc
AU - Psychogios, Marios N
AU - Spiotta, Alejandro
AU - Anadani, Mohammad
AU - Labeyrie, Marc-Antoine
AU - Mazighi, Mikael
AU - Biondi, Alessandra
AU - Richard, Sébastien
AU - Anxionnat, René
AU - Bracard, Serge
AU - Turjman, Francis
AU - Gory, Benjamin
AU - TITAN (Thrombectomy In TANdem Lesions) Investigators
PY - 2019/8/15
Y1 - 2019/8/15
N2 - 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.
AB - 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.
KW - Anticoagulation
KW - Endovascular Treatment
KW - Heparin
KW - Stroke
KW - Tandem occlusion
KW - Thrombectomy
UR - https://www.scopus.com/pages/publications/85066467531
U2 - 10.1007/s00270-019-02251-4
DO - 10.1007/s00270-019-02251-4
M3 - Journal article
C2 - 31152229
SN - 0174-1551
VL - 42
SP - 1160
EP - 1167
JO - Cardiovascular and Interventional Radiology
JF - Cardiovascular and Interventional Radiology
IS - 8
ER -