Carotid Stenting With Antithrombotic Agents and Intracranial Thrombectomy Leads to the Highest Recanalization Rate in Patients With Acute Stroke With Tandem Lesions
| Autor: | Panagiotis Papanagiotou, Diogo C. Haussen, Francis Turjman, Julien Labreuche, Michel Piotin, Andreas Kastrup, Henrik Steglich-Arnholm, Markus Holtmannspötter, Christian Taschner, Sebastian Eiden, Raul G. Nogueira, Maria Boutchakova, Adnan Siddiqui, Bertrand Lapergue, Franziska Dorn, Christophe Cognard, Monika Killer, Salvatore Mangiafico, Marc Ribo, Marios N. Psychogios, Alejandro Spiotta, Marc Antoine Labeyrie, Alessandra Biondi, Mikaël Mazighi, Sébastien Richard, René Anxionnat, Serge Bracard, Benjamin Gory, Jonathan Andrew Grossberg, Adrien Guenego, Julien Darcourt, Isabelle Vukasinovic, Elisa Pomero, Jason Davies, Leonardo Renieri, Corentin Hecker, Maria Muchada Muchada, Arturo Consoli, Georges Rodesch, Emmanuel Houdart, Raymond Turner, Aquilla Turk, Imran Chaudry, Paul-Emile Labeyrie, Roberto Riva, Johanna Lockau, Raphaël Blanc, Hocine Redjem, Daniel Behme, Hussain Shallwani, Maurer Christopher, Anne-Laure Derelle, Romain Tonnelet, Liang Liao, Camille Amaz |
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| Přispěvatelé: | Klinikum Bremen-Mitte, Emory University School of Medicine, Emory University [Atlanta, GA], Service de neuroradiologie [Lyon], Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Rigshospitalet [Copenhagen], Copenhagen University Hospital, Freiburg University Medical Center, State University of New York (SUNY), Hôpital Foch [Suresnes], University-Hospital Munich-Großhadern [München], Neuroradiologie Diagnostique et Thérapeutique [Toulouse], Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse], Paracelsus Medizinische Privatuniversität = Paracelsus Medical University (PMU), Azienda Ospedaliero-Universitaria Careggi (AOU Careggi), Vall d'Hebron University Hospital [Barcelona], University Medical Center Göttingen (UMG), Medical University of South Carolina [Charleston] (MUSC), Service de Neuroradiologie [CHU Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Service de neurologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy], Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Service Neuroradiologie diagnostique et interventionnelle [Hôpital Foch], Universitäts Klinikum Freiburg = University Medical Center Freiburg (Uniklinik), Service Neuroradiologie Diagnostique et Thérapeutique [CHU Toulouse], Pôle imagerie médicale [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Azienda Ospedaliero-Universitaria Careggi [Firenze] (AOUC) |
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Carotid Artery Diseases
Male medicine.medical_specialty Time Factors medicine.medical_treatment [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine 030204 cardiovascular system & hematology Brain Ischemia 03 medical and health sciences 0302 clinical medicine Fibrinolytic Agents Risk Factors Internal medicine Angioplasty medicine.artery Antithrombotic medicine [INFO.INFO-IM]Computer Science [cs]/Medical Imaging Humans cardiovascular diseases Registries ComputingMilieux_MISCELLANEOUS Aged Retrospective Studies Thrombectomy Intracerebral hemorrhage Univariate analysis Cerebral infarction business.industry Endovascular Procedures Thrombolysis Middle Aged medicine.disease United States 3. Good health Europe Stroke Treatment Outcome Cardiology Female Stents Internal carotid artery Carotid stenting Cardiology and Cardiovascular Medicine business 030217 neurology & neurosurgery [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology |
| Zdroj: | JACC: Cardiovascular Interventions JACC: Cardiovascular Interventions, Elsevier/American College of Cardiology, 2018, 11 (13), pp.1290-1299. ⟨10.1016/j.jcin.2018.05.036⟩ JACC: Cardiovascular Interventions, 2018, 11 (13), pp.1290-1299. ⟨10.1016/j.jcin.2018.05.036⟩ |
| ISSN: | 1936-8798 |
| DOI: | 10.1016/j.jcin.2018.05.036⟩ |
| Popis: | Objectives The aim of this study was to identify the optimal endovascular approach in patients with acute stroke with tandem lesions. Background At present, there is no consensus about the ideal technical strategy for the endovascular treatment of patients with acute ischemic stroke with tandem lesions of the extracranial internal carotid artery (ICA) and intracranial cerebral arteries. Methods This was an international, multicenter registry with a total of 482 patients with acute ischemic stroke and tandem lesions. Patients were treated by intracranial thrombectomy as well as 1 of the following 4 strategies: 1) acute carotid artery stenting of the extracranial ICA with antithrombotic agents; 2) acute carotid artery stenting of the extracranial ICA without antithrombotic agents; 3) balloon angioplasty of the extracranial ICA; and 4) intracranial thrombectomy alone. The main outcome endpoints of the study were the degree of recanalization and the 90-day clinical outcome. The safety endpoints were symptomatic intracerebral hemorrhage and all causes of mortality at 90 days. Results Using univariate analysis, the rates of successful reperfusion (modified Thrombolysis in Cerebral Infarction grades 2B and 3) and favorable clinical outcome after 90 days were significantly higher after acute carotid stenting with antithrombotic therapy and thrombectomy compared with the group with thrombectomy alone. After adjusting for confounding variables, acute stenting with antithrombotic therapy was independently associated with successful recanalization (odds ratio: 2.4; 95% confidence interval: 1.25 to 4.59; p = 0.008). The rates of symptomatic intracerebral hemorrhage and 90-day mortality were comparable among all 4 treatment groups. Conclusions Acute stenting of the extracranial ICA with antithrombotic therapy in combination with intracranial thrombectomy is associated with higher recanalization rates in treatment of patients with acute stroke with tandem lesions. |
| Databáze: | OpenAIRE |
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