Endovascular treatment of acute tandem lesions in patients with mild anterior circulation stroke.

Autor:	Meyer L; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany lu.meyer@uke.de., Politi M; Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte gGmbH, Bremen, Germany.; Interventional Radiology Unit, Evangelismos General Hospital, Athens, Greece., Alexandrou M; Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte gGmbH, Bremen, Germany., Roth C; Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte gGmbH, Bremen, Germany., Kastrup A; Department of Neurology, Hospital Bremen-Mitte gGmbH, Bremen, Germany., Mpotsaris A; Department of Diagnostic and Interventional Neuroradiology, University Hospital of Magdeburg, Magdeburg, Germany., Hanning U; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Flottmann F; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Brekenfeld C; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Deb-Chatterji M; Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Thomalla G; Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Kniep H; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Faizy TD; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Bechstein M; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Broocks G; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Herzberg M; Department of Radiology, University Hospital Würzburg, Würzburg, Germany.; Institute of Neuroradiology, Ludwig Maximilians Universität, München, Germany., Feil K; Department of Neurology, Ludwig Maximilians Universität, München, Germany.; Department of Neurology and Stroke, Eberhard-Karls University, Tübingen, Germany., Kellert L; Department of Neurology, Ludwig Maximilians Universität, München, Germany., Dorn F; Institute of Neuroradiology, Ludwig Maximilians Universität, München, Germany.; Department of Neuroradiology, University Hospital Bonn, Bonn, Germany., Zeleňák K; Clinic of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia., Fiehler J; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Papanagiotou P; Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte gGmbH, Bremen, Germany.; Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Jazyk:	angličtina
Zdroj:	Journal of neurointerventional surgery [J Neurointerv Surg] 2023 Sep; Vol. 15 (e1), pp. e136-e141. Date of Electronic Publication: 2022 Aug 26.
DOI:	10.1136/jnis-2022-019239
Abstrakt:	Background: In patients with mild strokes the risk-benefit ratio of endovascular treatment (EVT) for tandem lesions has yet to be evaluated outside of current guideline recommendations. This study investigates the frequency as well as procedural and safety outcomes in daily clinical practice. Methods: Using data from the German Stroke Registry-Endovascular Treatment (GSR-ET) we analyzed patients with anterior circulation stroke due to tandem-lesions and mild deficits. These patients were defined as ≤5 on the National Institutes of Health Stroke Scale (NIHSS). Recanalization was assessed with the modified Thrombolysis in Cerebral Infarction Scale (mTICI). Early neurological and long-term functional outcomes were assessed with the NIHSS change and modified Rankin scale (mRS), respectively. Safety assessment included periprocedural complications and the rate of symptomatic intracerebral hemorrhage (sICH). Results: A total of 61 patients met the inclusion criteria and were treated endovascularly for tandem lesions. The median age was 68 (IQR:59-76) and 32.9% (20) were female. Patients were admitted to the hospital with a median NIHSS score of 4 (IQR:2-5) and a median Alberta Stroke Programme Early CT Score (ASPECTS) of 9 (IQR:8-10). Successful recanalization (mTICI 2b-3) was observed in 86.9% (53). NIHSS decreased non-significantly (p=0.382) from baseline to two points (IQR:1-9) at discharge. Excellent (mRS≤1) and favorable (mRS≤2) long-term functional outcome at 90-days was 55.8% (29) and 69.2% (36), respectively. Mortality rates at 90-days were 9.6% (5) and sICH occurred in 8.2% (5). Conclusions: EVT for tandem lesions in patients with mild anterior circulation stroke appears to be feasible but may lead to increased rates of sICH. Further studies comparing endovascular with best medical treatment (BMT) especially investigating the risk of periprocedural hemorrhagic complications, are needed. Competing Interests: Competing interests: J. Fiehler: research support from the German Ministry of Science and Education (BMBF), German Ministry of Economy and Innovation (BMWi), German Research Foundation (DFG), European Union (EU), Hamburgische Investitions-/Förderbank (IFB), Medtronic, Microvention, Philips, Stryker; consultancy appointments; Acandis, Bayer, Boehringer Ingelheim, Cerenovus, Covidien, Evasc Neurovascular, MD Clinicals, Medtronic, Medina, Microvention, Penumbra, Route92, Stryker, Transverse Medical; stock holdings for Tegus, JNIS Associate Editor.F. Dorn: Associate Editor for JNIS and JCM; Research funding from Cerenovus/ Johnson&Johnson; Consulting for Cerenovus, Balt, Cerus Endovascular; Speaker, Acandis, Stryker; Payment for expert testimony for Cerenovus; Advisory Board Cerenovus.T. Faizy: Eppdata GmbH; German Research Foundation Scholarship Grant.L. Meyer: Compensation as a speaker for Balt Prime.G. Broocks: Compensation as a speaker for Balt PrimeL. Kellert: AstraZeneca, Bayer Vital, Boehringer Ingelheim, Bristol-Meyer-Squibb, Daiichi Sankyo, and Pfizer K. Feil: Intramurale AKF Förderung UKT; Böhringer Ingelheim LEXI; Pfizer.H. Kniep: Permanent consultant with Eppdata GmbH, Hamburg, Germany; Anonymous funding for participating at ESMINT congress 2022 (travel, accommodation).G. Thomalla: EU: TENSION trial, EU: PRECIOUS trial, German Innovation Fund: StroCare, Acandis, Stryker, Alexion, Amarin, Bayer, Boehringer Ingelheim BristolMyersSquibb/Pfizer, Daiichi Sankyo, ESO board of directors, DGN guideline writing group (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu