RT Journal Article
SR Electronic
T1 Endovascular therapy with or without intravenous thrombolysis in acute stroke with tandem occlusion
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP neurintsurg-2020-017202
DO 10.1136/neurintsurg-2020-017202
A1 Mohammad Anadani
A1 Gaultier Marnat
A1 Arturo Consoli
A1 Panagiotis Papanagiotou
A1 Raul G Nogueira
A1 Alejandro M Spiotta
A1 Romain Bourcier
A1 Maeva Kyheng
A1 Julien Labreuche
A1 Adnan H Siddiqui
A1 Marc Ribo
A1 Adam de Havenon
A1 Urs Fischer
A1 Igor Sibon
A1 Cyril Dargazanli
A1 Caroline Arquizan
A1 Christophe Cognard
A1 Jean Marc Olivot
A1 René Anxionnat
A1 Gérard Audibert
A1 Mikael Mazighi
A1 Raphael Blanc
A1 Bertrand Lapergue
A1 Sébastien Richard
A1 Benjamin Gory
A1 TITAN (Thrombectomy In TANdem lesions) Investigators
A1 ,
YR 2021
UL http://jnis.bmj.com/content/early/2021/04/27/neurintsurg-2020-017202.abstract
AB Background Endovascular therapy (EVT) is effective and safe in patients with tandem occlusion. The benefit of intravenous thrombolysis (IVT) prior to EVT in acute tandem occlusion is debatable.Objective To compare EVT alone with EVT plus IVT in patients with acute ischemic stroke due to anterior circulation tandem occlusions.Methods This is an individual patient pooled analysis of the Thrombectomy In TANdem lesions (TITAN) and Endovascular Treatment in Ischemic Stroke (ETIS) Registries. Patients were divided into two groups based on prior IVT treatment: (1) IVT+ group, which included patients who received IVT prior to EVT, (2) IVT− group, which included patients who did not receive IVT prior to EVT. Propensity score (inverse probability of treatment weighting (IPTW)) was used to reduce baseline between-group differences. The primary outcome was favorable outcome—that is, modified Rankin Scale (mRS) score 0 to 2 at 90 days.Results Overall, 602 consecutive patients with an acute stroke with tandem occlusion were included (380 and 222 in the bridging therapy and EVT alone groups, respectively). Onset to imaging time was shorter in the IVT+ group (median 103 vs 140 min). In contrast, imaging to puncture time was longer in the IVT+ group (median 107 vs 91 min). In IPTW analysis, the IVT+ group had higher odds of favorable outcome, excellent outcome (90-day mRS score 0–1), and successful reperfusion (modified Thrombolysis in Cerebral Infarction score 2b/3 at the end of EVT). There was no difference in the risk of significant hemorrhagic complications between groups. In secondary analysis of patients treated with acute cervical internal carotid artery stenting, bridging therapy was associated with higher odds of favorable outcome and lower odds of mortality at 90 days.Conclusions Our results suggest that bridging therapy in patients with acute ischemic stroke due to anterior tandem occlusion is safe and may improve functional outcome, even in the setting of acute cervical internal carotid artery stenting during EVT.The data that support the findings of this study are available from the corresponding author upon reasonable request.