Endovascular Therapy of Anterior Circulation Tandem Occlusions: Pooled Analysis From the TITAN and ETIS Registries.

Mohammad Anadani, Gaultier Marnat, Arturo Consoli, Panagiotis Papanagiotou, Raul G. Nogueira, Adnan Siddiqui, Marc Ribo, Alejandro M. Spiotta, Romain Bourcier, Maeva Kyheng, Julien Labreuche, Adam de Havenon, Igor Sibon, Cyril Dargazanli, Caroline Arquizan, Christophe Cognard, Jean-Marc Olivot, René Anxionnat, Gérard Audibert, Mikaël Mazighi, Raphaël Blanc, Bertrand Lapergue, Sébastien Richard, Benjamin Gory, Francis Turjman, Michel Piotin, Henrik Steglich-Arnholm, Markus Holtmannspötter, Christian Taschner, Sebastian Eiden, Diogo C. Haussen, Maria Boutchakova, Franziska Dorn, Monika Killer-Oberpfalzer, Salvatore Mangiafico, Marios N. Psychogios, Marc-Antoine Labeyrie, Alessandra Biondi, Serge Bracard, Jonathan Andrew Grossberg, Adrien Guenego, Julien Darcourt, Isabelle Vukasinovic, Elisa Pomero, Jason Davies, Leonardo Renieri, Corentin Hecker, Maria Muchada Muchada, Georges Rodesch, Emmanuel Houdart, Johanna Lockau, Andreas Kastrup, Hocine Redjem, Daniel Behme, Hussain Shallwani, Maurer Christopher, Gioia Mione, Lisa Humbertjean, Nolwenn Riou-Comte, François Zhu, Anne-Laure Derelle, Liang Liao, Simon Escalard, Benjamin Maïer, Jean-Philippe Desilles, Gabriele Ciccio, Stanislas Smajda, Mikael Obadia, Candice Sabben, Ovide Corabianu, Thomas de Broucker, Didier Smadja, Sonia Alamowitch, Olivier Ille, Eric Manchon, Pierre-Yves Garcia, Guillaume Taylor, Malek Ben Maacha, Adrien Wang, Serge Evrard, Maya Tchikviladze, Nadia Ajili, David Weisenburger, Lucas Gorza, Oguzhan Coskun, Federico Di Maria, Georges Rodesh, Morgan Leguen, Julie Gratieux, Fernando Pico, Haja Rakotoharinandrasana, Philippe Tassan, Roxanna Poll, Sylvie Marinier, Florent Gariel, Xavier Barreau, Jérôme Berge, Louis Veunac, Patrice Menegon, Ludovic Lucas, Stéphane Olindo, Pauline Renou, Sharmila Sagnier, Mathilde Poli, Sabrina Debruxelles, Thomas Tourdias, Jean-Sebastien Liegey, Lili Detraz, Benjamin Daumas-Duport, Pierre-Louis Alexandre, Monica Roy, Cédric Lenoble, Vincent L’allinec, Jean-Baptiste Girot, Hubert Desal, Fatiha Bechiri, Marc Braun, Romain Tonnelet, Emmanuelle Schmitt, Sophie Planel, Jean-Christophe Lacour, Gabriela Hossu, Marine Beaumont, Mitchelle Bailang, Marie Reitter, Agnès Masson, Lionel Alb, Adriana Tabarna, Marcela Voicu, Iona Podar, Madalina Brezeanu, Sarah Guy, Vincent Costalat, Grégory Gascou, Pierre-Henri Lefèvre, Imad Derraz, Carlos Riquelme, Nicolas Gaillard, Isabelle Mourand, Lucas Corti,
Stroke. 2021-10-01; 52(10): 3097-3105
DOI: 10.1161/strokeaha.120.033032


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Background and Purpose:
Endovascular therapy for tandem occlusion strokes of the anterior circulation is an effective and safe treatment. The best treatment approach for the cervical internal carotid artery (ICA) lesion is still unknown. In this study, we aimed to compare the functional and safety outcomes between different treatment approaches for the cervical ICA lesion during endovascular therapy for acute ischemic strokes due to tandem occlusion in current clinical practice.

Methods:
Individual patients’ data were pooled from the French prospective multicenter observational ETIS (Endovascular Treatment in Ischemic Stroke) and the international TITAN (Thrombectomy in Tandem Lesions) registries. TITAN enrolled patients from January 2012 to September 2016, and ETIS from January 2013 to July 2019. Patients with acute ischemic stroke due to anterior circulation tandem occlusion who were treated with endovascular therapy were included. Patients were divided based on the cervical ICA lesion treatment into stent and no-stent groups. Outcomes were compared between the two treatment groups using propensity score methods.

Results:

A total of 603 patients were included, of whom 341 were treated with acute cervical ICA stenting. In unadjusted analysis, the stent group had higher rate of favorable outcome (90-day modified Rankin Scale score, 0–2; 57% versus 45%) and excellent outcome (90-day modified Rankin Scale score, 0–1; 40% versus 27%) compared with the no-stent group. In inverse probability of treatment weighting propensity score–adjusted analyses, stent group had higher odds of favorable outcome (adjusted odds ratio, 1.09 [95% CI, 1.01–1.19];
P
=0.036) and successful reperfusion (modified Thrombolysis in Cerebral Ischemia score, 2b-3; adjusted odds ratio, 1.19 [95% CI, 1.11–1.27];
P
<0.001). However, stent group had higher odds of any intracerebral hemorrhage (adjusted odds ratio, 1.10 [95%, 1.02–1.19];
P
=0.017) but not higher rate of symptomatic intracerebral hemorrhage or parenchymal hemorrhage type 2. Subgroup analysis demonstrated heterogeneity according to the lesion type (atherosclerosis versus dissection;
P
for heterogeneity, 0.01), and the benefit from acute carotid stenting was only observed for patients with atherosclerosis.

Conclusions:
Patients treated with acute cervical ICA stenting for tandem occlusion strokes had higher odds of 90-day favorable outcome, despite higher odds of intracerebral hemorrhage; however, most of the intracerebral hemorrhages were asymptomatic.

Auteurs Bordeaux Neurocampus