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 314
OP 320
DO 10.1136/neurintsurg-2020-017202
VO 14
IS 4
A1 Anadani, Mohammad
A1 Marnat, Gaultier
A1 Consoli, Arturo
A1 Papanagiotou, Panagiotis
A1 Nogueira, Raul G
A1 Spiotta, Alejandro M
A1 Bourcier, Romain
A1 Kyheng, Maeva
A1 Labreuche, Julien
A1 Siddiqui, Adnan H
A1 Ribo, Marc
A1 de Havenon, Adam
A1 Fischer, Urs
A1 Sibon, Igor
A1 Dargazanli, Cyril
A1 Arquizan, Caroline
A1 Cognard, Christophe
A1 Olivot, Jean Marc
A1 Anxionnat, René
A1 Audibert, Gérard
A1 Mazighi, Mikael
A1 Blanc, Raphael
A1 Lapergue, Bertrand
A1 Richard, Sébastien
A1 Gory, Benjamin
A1 ,
A1 ,
YR 2022
UL http://jnis.bmj.com/content/14/4/314.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.