PT  - JOURNAL ARTICLE
AU  - Anadani, Mohammad
AU  - Marnat, Gaultier
AU  - Consoli, Arturo
AU  - Papanagiotou, Panagiotis
AU  - Nogueira, Raul G
AU  - Spiotta, Alejandro M
AU  - Bourcier, Romain
AU  - Kyheng, Maeva
AU  - Labreuche, Julien
AU  - Siddiqui, Adnan H
AU  - Ribo, Marc
AU  - de Havenon, Adam
AU  - Fischer, Urs
AU  - Sibon, Igor
AU  - Dargazanli, Cyril
AU  - Arquizan, Caroline
AU  - Cognard, Christophe
AU  - Olivot, Jean Marc
AU  - Anxionnat, René
AU  - Audibert, Gérard
AU  - Mazighi, Mikael
AU  - Blanc, Raphael
AU  - Lapergue, Bertrand
AU  - Richard, Sébastien
AU  - Gory, Benjamin
AU  - ,
ED  - ,
TI  - Endovascular therapy with or without intravenous thrombolysis in acute stroke with tandem occlusion
AID  - 10.1136/neurintsurg-2020-017202
DP  - 2022 Apr 01
TA  - Journal of NeuroInterventional Surgery
PG  - 314--320
VI  - 14
IP  - 4
4099  - http://jnis.bmj.com/content/14/4/314.short
4100  - http://jnis.bmj.com/content/14/4/314.full
SO  - J NeuroIntervent Surg2022 Apr 01; 14
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.