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

Autor:	Anadani M; Department of Neurology, Washington University School of Medicine, St. Louis (M.A., A.d.H.).; Department of Neurosurgery, Medical University of South Carolina, Charleston (A.M.S., M.A.)., Marnat G; Departments of Diagnostic and Interventional Neuroradiology (G.M.), University Hospital of Bordeaux, France., Consoli A; Departments of Diagnostic and Interventional Neuroradiology (A.C.), Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France., Papanagiotou P; Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Germany (P.P.)., Nogueira RG; Department of Neurology, Emory University/Grady Memorial Hospital, Atlanta (R.G.N.)., Siddiqui A; Department of Neurosurgery, State University of New York, Buffalo (A.S.)., Ribo M; Department of Neurology, Hospital Vall D'Hebron, Barcelona, Spain (M.R.)., Spiotta AM; Department of Neurosurgery, Medical University of South Carolina, Charleston (A.M.S., M.A.)., Bourcier R; Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, L'institut du thorax, INSERM 1087, CNRS, Université de Nantes, France (R.B.)., Kyheng M; University Lille, CHU Lille, EA 2694, Santé Publique: épidémiologie et Qualité des Soins, France (M.K., J.L.)., Labreuche J; University Lille, CHU Lille, EA 2694, Santé Publique: épidémiologie et Qualité des Soins, France (M.K., J.L.)., de Havenon A; Department of Neurology, Washington University School of Medicine, St. Louis (M.A., A.d.H.)., Sibon I; Neurology, Stroke Center (I.S.), University Hospital of Bordeaux, France., Dargazanli C; Departments of Interventional Neuroradiology (C.D.), CHRU Gui de Chauliac, Montpellier, France., Arquizan C; Neurology (C.A.), CHRU Gui de Chauliac, Montpellier, France., Cognard C; Department of Neuroradiology (C.C.), University Hospital of Toulouse, France., Olivot JM; Stroke Unit, Department of Neurology (J.-M.O.), University Hospital of Toulouse, France., Anxionnat R; Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine (R.A., B.G.), CHRU-Nancy, France.; IADI, INSERM U1254, Université de Lorraine, Nancy, France (R.A., B.G.)., Audibert G; Department of Anesthesiology and Surgical Intensive Care, Université de Lorraine (G.A.), CHRU-Nancy, France., Mazighi M; Department of Interventional Neuroradiology, Rothschild Foundation, University of Paris, INSERM U1148, France (M.M., R.B.)., Blanc R; Department of Interventional Neuroradiology, Rothschild Foundation, University of Paris, INSERM U1148, France (M.M., R.B.)., Lapergue B; Neurology (B.L.), Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France., Richard S; Stroke Unit, Department of Neurology, Université de Lorraine (S.R.), CHRU-Nancy, France.; and INSERM U1116 (S.R.), CHRU-Nancy, France., Gory B; Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine (R.A., B.G.), CHRU-Nancy, France.; IADI, INSERM U1254, Université de Lorraine, Nancy, France (R.A., B.G.).
Jazyk:	angličtina
Zdroj:	Stroke [Stroke] 2021 Oct; Vol. 52 (10), pp. 3097-3105. Date of Electronic Publication: 2021 Aug 10.
DOI:	10.1161/STROKEAHA.120.033032
Abstrakt:	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.
Databáze:	MEDLINE
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