Successful Thrombectomy Improves Functional Outcome in Tandem Occlusions with a Large Ischemic Core.
World Neurosurgery. 2023-10-01; 178: e282-e291
DOI: 10.1016/j.wneu.2023.07.043
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Gory B(1), Finitsis S(2), Desilles JP(3), Consoli A(4), Mazighi M(3), Marnat G(5), Sibon I(6), Pop R(7), Raposo N(8), Wolff V(9), Cognard C(10), Richard
S(11), Moulin S(12), Soize S(13), Lapergue B(14), Olivot JM(8); ETIS Registry
Investigators.
Collaborators: Lapergue B, Wang A, Consoli A, Coskun O, Maria FD, Pizzuto S,
Sgreccia A, Benoit C, Gorza L, Weisenburger-Lile D, Jabeur W, Maia T, Evrard S,
Rodesch G, Blanc R, Obadia M, Desilles JP, Piotin M, Seners P, Smajda S,
Escalard S, Maier B, Sabben C, Redjem H, Mikaelmazhigi, Adwan G, Delvoye F,
Raaisi AA, Boisseau W, Eker O, Cho TH, Derex L, Fontaine J, Mechtouff L,
Nighoghossian N, Ong E, Rascle L, Riva R, Turjman F, Laubacher M, Beyragued M,
Berthezene Y, Hermier M, Roxanna A, Bani-Sadr A, Filip A, Cappucci M, Bourcier
R, Duport BD, Alexandre PL, Lenoble C, Hubertdesal, Gaalon S, Guillon B,
Preterre C, Tessier G, Lionnet A, Gory B, Humbertjean-Selton L, Anxionnat R,
Derelle AL, Liao L, Schmitt E, Planel S, Richard S, Mione G, Lacour JC,
Douarinou M, Micard E, Chen B, Audibert G, Masson A, Alb L, Beaumont M, Tabarna
A, Voicu M, Barthel G, Podar I, Brezeanu M, Reitter M, Zhu F, Marnat G, Liegey
JS, Briau P, Papillon L, Sibon I, Barreau X, Papaxanthos J, Berge J, Debruxelles
S, Olindo S, Poli M, Renou P, Sagnier S, Tourdias T, Courret T, Lucas L,
Milnerowicz M, Dargazanli C, Costalat V, Mourand I, Arquizan C, Corti L, Adrien,
Schiphorst T, Federico C, Derraz I, Mahmoudi M, Lefevre PH, Gascou G, Spelle L,
Caroff J, Denier C, Chalumeau V, Mihalea C, Nicolaslegris, Ozanne A, Ikka L,
Chassin O, Gallas S, Venditti L, Marianasarov, Cortese J, Ferre JC, Vannier S,
Ronziere T, Veronica Lassalle M, Gauvrit JY, Tracol C, Boustia AF, Malrain C,
Beaufreton E, Lapotre T, Alias Q, Hissier J, Guillen M, Eugene F, Chivot C,
Courselle A, Ouin E, Lamy C, Delaforge K, Fernandez M, Vial J, Laferte Q,
Desdoit X, Timsit S, Jourdain A, Gentric JC, Ognard J, Viakhireva I, Coris J,
Prud’hon S, Merrien FM, Marechal D, Bruguet M, Rousseau PY, Goas P, Boulanger M,
Touze E, Vivien D, Barbier C, Schneckenburger R, Salaris F, Cogez J, Guettier S,
Porte E, Bouchart J, Mounayer C, Rouchaud A, Saleme S, Forestier G, Clarencon F,
Rosso C, Leder S, Baronnet F, Crozier S, Leger A, Premat K, Eimad S, Lenck S,
Sourour N, Bottin L, Ghazanfari S, Yger M, Alamowitch S, Delorme S, Wittwer A,
Vassilev C, Naggara O, Turc G, Hassen WB, Kerleroux B, Trystram D,
Rodriguez-Regent C, Ozkul-Wermester O, Papagiannaki C, Massardier E, Triquenot
A, Lefebvre M, Burel J, Viguier A, Cognard C, Januel AC, Albucher JF, Calviere
L, Olivot JM, Darcourt J, Raposo N, Bonneville F, Bellanger G, Fontaine L, Tall
P, Thalamas C, Geerearts T, Grepon AF, Bourdain F, Bernady P, Ballan G, Bannier
S, Ellie E, Flabeau O, Potenza J, Soulages A, Lagoarde-Segot L, Cailliez H,
Veunac L, Higue D, Lebras A, Adam S, Pegat B, Guen AL, Chedeville F, Jouan J,
Demasles S, Richter JS, Thierry Barroso B, Dahan C, Gonnet A, Hubrecht R, Lepine
Z, Castagnet H, Marasescu R, Heck O, Cuisenier P, Detante O, Wiki IF, Bonaz C,
Garambois K, Legris L, Kastler A, Boubagra K, Berthet C, Charara S, Wolff V, Pop
R, Quenardelle V, Lauer V, Pierre-Paul I, Roxanagheoca, Trzeciak M, Moulin S,
Tuan HV, Pagano P, Doucet A, Gelmini C, Manceau P, Paiusan L, Serre I, Soize S,
Phuong Nguyen TN, Sahnoun M, Caucheteux N, Ferrier A, Zerroug A, Moreno R,
Chabert E, Lteif E, Paulineparis, Bourgois N, Raquin M, Pasco-Papon A, Girot JB,
Lecluse A, Godard S, L’allinec V, Janot K, Bibi R, Gaudron M, Bretonniere A,
Annan M, Ifergan H, Boulouis G, Pasi M, Debiais S, Molinier E, Wietrich A, Ruche
V, Lavandier K, Bejot Y, Lemogne B, Ricolfi F, Baptiste L, Thouant P, Duloquin
G, Olivier Comby P, Charbonnier G, Bonnet L, Raybaud N, Bouamra B, Moulin T,
Biondi A.
Author information:
(1)Department of Diagnostic and Therapeutic Neuroradiology, Université de
Lorraine, IADI, INSERM U1254, CHRU-Nancy, Nancy, France. Electronic address:
.
(2)Department of Neuroradiology, Aristotle University of Thessaloniki, Ahepa
Hospital, Thessaoniki, Greece.
(3)Department of Interventional Neuroradiology, Rothschild Foundation, Paris,
France.
(4)Department of Diagnostic and Interventional Neuroradiology, Foch Hospital,
Versailles Saint-Quentin en Yvelines University, Suresnes, France.
(5)Department of Diagnostic and Interventional Neuroradiology, University
Hospital of Bordeaux, Bordeaux, France.
(6)Department of Neurology, Stroke Center, University Hospital of Bordeaux,
Bordeaux, France.
(7)Department of Interventional Neuroradiology, University Hospital of
Strasbourg, Strasbourg, France.
(8)Department of Neurology, Acute Stroke Unit, CIC 1436-UMR 1214, CHU Toulouse,
Toulouse, France.
(9)Stroke Unit, University Hospital of Strasbourg, Strasbourg, France.
(10)Department of Neuroradiology, CHU Toulouse, Toulouse, France.
(11)Department of Neurology, Stroke Unit, Université de Lorraine, INSERM U1116,
CHRU-Nancy, Nancy, France.
(12)Department of Neurology, Hôpital Maison Blanche, University Hospital of
Reims, Université Reims Champagne-Ardenne, Reims, France.
(13)Department of Neuroradiology, Hôpital Maison Blanche, University Hospital of
Reims, Université Reims Champagne-Ardenne, Reims, France.
(14)Department of Neurology, Foch Hospital, Versailles Saint-Quentin en Yvelines
University, Suresnes, France.
BACKGROUND: Emergent stenting in tandem occlusions and mechanical thrombectomy
(MT) of acute ischemic stroke related to large vessel occlusion (LVO-AIS) with a
large core are tested independently. We aim to assess the impact of reperfusion
with MT in patients with LVO-AIS with a large core and a tandem occlusion and to
compare the safety of reperfusion between large core with tandem and nontandem
occlusions in current practice.
METHODS: We analyzed data of all consecutive patients included in the
prospective Endovascular Treatment in Ischemic Stroke Registry in France between
January 2015 and March 2023 who presented with a pretreatment ASPECTS (Alberta
Stroke Program Early CT Score) of 0-5 and angiographically proven tandem
occlusion. The primary end point was a favorable outcome defined by a modified
Rankin Scale (mRS) score of 0-3 at 90 days.
RESULTS: Among 262 included patients with a tandem occlusion and ASPECTS 0-5,
203 patients (77.5%) had a successful reperfusion (modified Thrombolysis in
Cerebral Infarction grade 2b-3). Reperfused patients had a favorable shift in
the overall mRS score distribution (adjusted odds ratio [aOR], 1.57 [1.22-2.03];
P < 0.001), higher rates of mRS score 0-3 (aOR, 7.03 [2.60-19.01]; P < 0.001)
and mRS score 0-2 at 90 days (aOR, 3.85 [1.39-10.68]; P = 0.009) compared with
nonreperfused. There was a trend between the occurrence of successful
reperfusion and a decreased rate of symptomatic intracranial hemorrhage (aOR,
0.5 [0.22-1.13]; P = 0.096). Similar safety outcomes were observed after large
core reperfusion in tandem and nontandem occlusions.
CONCLUSIONS: Successful reperfusion was associated with a higher rate of
favorable outcome in large core LVO-AIS with a tandem occlusion, with a safety
profile similar to nontandem occlusion.
Copyright © 2023 Elsevier Inc. All rights reserved.
DOI: 10.1016/j.wneu.2023.07.043
PMID: 37473866 [Indexed for MEDLINE]