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Endovascular therapy with or without intravenous thrombolysis in acute stroke with tandem occlusion

Mohammad Anadani 1, 2 Gaultier Marnat 3 Arturo Consoli 4, 5, 6 Panagiotis Papanagiotou 7 Raul Nogueira 8 Alejandro Spiotta 2 Romain Bourcier 9 Maeva Kyheng 10 Julien Labreuche 10 Adnan Siddiqui 11 Marc Ribo 12 Adam de Havenon 13 Urs Fischer 14 Igor Sibon 15 Cyril Dargazanli 16 Caroline Arquizan 17 Christophe Cognard 18 Jean Marc Olivot 19 René Anxionnat 5, 20 Gérard Audibert 21 Mikael Mazighi 22 Raphael Blanc 22 Bertrand Lapergue 6 Sébastien Richard 23 Benjamin Gory 5, 20
Abstract : 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.
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https://hal.univ-lorraine.fr/hal-03224258
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Submitted on : Tuesday, May 11, 2021 - 3:09:40 PM
Last modification on : Wednesday, October 20, 2021 - 12:24:16 AM

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Mohammad Anadani, Gaultier Marnat, Arturo Consoli, Panagiotis Papanagiotou, Raul Nogueira, et al.. Endovascular therapy with or without intravenous thrombolysis in acute stroke with tandem occlusion. Journal of Neurointerventional Surgery, BMJ Journals, In press, pp.neurintsurg-2020-017202. ⟨10.1136/neurintsurg-2020-017202⟩. ⟨hal-03224258⟩

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