Thrombolysis Improves Reperfusion and the Clinical Outcome in Tandem Occlusion Stroke Related to Cervical Dissection: TITAN and ETIS Pooled Analysis
| Autor: | Mikael Mazighi, Titan Investigators, Gérard Audibert, Sébastien Richard, Mohammad Anadani, Florent Gariel, Michel Piotin, Raphaël Blanc, Bertrand Lapergue, Julien Labreuche, Romain Bourcier, Igor Sibon, Gaultier Marnat, Arturo Consoli, Cyril Dargazanli, Maeva Kyheng, Benjamin Gory, René Anxionnat |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment internal carotid artery Modified Rankin Scale medicine.artery Occlusion Clinical endpoint Diseases of the circulatory (Cardiovascular) system Medicine Stroke thrombolytic therapy business.industry Thrombolysis Odds ratio medicine.disease stroke reperfusion Surgery Dissection dissection RC666-701 Original Article Neurology (clinical) Internal carotid artery Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of Stroke, Vol 23, Iss 3, Pp 411-419 (2021) Journal of Stroke |
| ISSN: | 2287-6405 2287-6391 |
| Popis: | Background and Purpose Despite the widespread adoption of mechanical thrombectomy (MT) for the treatment of large vessel occlusion stroke (LVOS) in the anterior circulation, the optimal strategy for the treatment tandem occlusion related to cervical internal carotid artery (ICA) dissection is still debated. This individual patient pooled analysis investigated the safety and efficacy of prior intravenous thrombolysis (IVT) in anterior circulation tandem occlusion related to cervical ICA dissection treated with MT.Methods We performed a retrospective analysis of two merged prospective multicenter international real-world observational registries: Endovascular Treatment in Ischemic Stroke (ETIS) and Thrombectomy In TANdem occlusions (TITAN) registries. Data from MT performed in the treatment of tandem LVOS related to cervical ICA dissection between January 2012 and December 2019 at 24 comprehensive stroke centers were analyzed. The primary endpoint was a favorable outcome defined as 90-day modified Rankin Scale (mRS) score of 0–2.Results The study included 144 patients with tandem occlusion LVOS due to cervical ICA dissection, of whom 94 (65.3%) received IVT before MT. Prior IVT was significantly associated with a better clinical outcome considering the mRS shift analysis (common odds ratio, 2.59; 95% confidence interval [CI], 1.35 to 4.93; P=0.004 for a 1-point improvement) and excellent outcome (90-day mRS 0–1) (adjusted odds ratio [aOR], 4.23; 95% CI, 1.60 to 11.18). IVT was also associated with a higher rate of intracranial successful reperfusion (83.0% vs. 64.0%; aOR, 2.70; 95% CI, 1.21 to 6.03) and a lower rate of symptomatic intracranial hemorrhage (4.3% vs. 14.8%; aOR, 0.21; 95% CI, 0.05 to 0.80).Conclusions Prior IVT before MT for the treatment of tandem occlusion related to cervical ICA dissection was safe and associated with an improved 90-day functional outcome. |
| Databáze: | OpenAIRE |
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