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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 Panagiotis Papanagiotou 5 Raul Nogueira 6 Alejandro Spiotta 2 Romain Bourcier 7 Maeva Kyheng 8 Julien Labreuche 8 Adnan Siddiqui 9 Marc Ribo 10 Adam de Havenon 11 Urs Fischer 12 Igor Sibon 13 Cyril Dargazanli 14 Caroline Arquizan 15 Christophe Cognard 16 Jean Marc Olivot 17, 18 René Anxionnat 19, 20 Gérard Audibert 21 Mikael Mazighi 22 Raphaël Blanc 22 Bertrand Lapergue 23, 24 Sébastien Richard 25 Benjamin Gory 20, 19 Francis Turjman Michel Piotin Henrik Steglich-Arnholm Markus Holtmannspötter Christian Taschner Sebastian Eiden Diogo C. Haussen Waqas Muhammad Maria Boutchakova Franziska Dorn Monika Killer-Oberpfalzer Salvatore Mangiafico Marios-Nikos Psychogios Marc-Antoine Labeyrie Alessandra Biondi Serge Bracard Jonathan Andrew Grossberg Adrien Guenego Julien Darcourt Isabelle Vukasinovic Elisa Pomero Jason Davies Leonardo Renieri Corentin Hecker Maria Muchada Muchada Georges Rodesch Emmanuel Houdart Johanna Lockau Andreas Kastrup Hocine Redjem Daniel Behme Hussain Shallwani Maurer Christopher Gioia Mione Lisa Humbertjean Nolwenn Riou-Comte François Zhu Anne-Laure Borderelle Liang Liao Simon Escalard Jean-Philippes Desilles Gabriele Ciccio Stanislas Smajda Mikael Obadia Candice Sabben Ovide Corabianu Thomas de Broucker Didier Smadja Sonia Alamowitch Olivier Ille Éric Manchon Pierre-Yves Garcia Guillaume Taylor Malek Ben Maacha Adrien Wang Serge Evrard Maya Tchikviladze Nadia Ajili David Weisenburger Lucas Gorza Oguzhan Coskun Federico Di Maria Georges Rodesh Morgan Leguen Julie Gratieux Fernando Pico Haja Rakotoharinandrasana Philippe Tassan Roxanna Poll Sylvie Marinier Florent Gariel Xavier Barreau Jérôme Berge Louis Veunac Patrice Menegon Ludovic Lucas Stéphane Olindo Pauline Renou Sharmila Sagnier Mathilde Poli Sabrina Debruxelles Thomas Tourdias Jean-Sébastien Liegey Benjamin Daumas-Duport Pierre-Louis Alexandre Monica Roy Cédric Lenoble Vincent L'Allinec Jean-Baptiste Girot Hubert Desal Marc Braun Anne-Laure Derelle Romain Tonnelet Emmanuelle Schmitt Sophie Planel Jean-Christophe Lacour Gabriela Hossu Marine Beaumont Mitchelle Bailang Marie Reitter Agnès Masson Lionel Alb Adriana Tabarna Marcela Voicu Iona Podar Madalina Brezeanu Vincent Costalat 26, 27 Gregory Gascou Pierre-Henri Lefevre Imad Derraz Carlos Riquelme Nicolas Gaillard Isabelle Mourand Lucas Corti 
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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Submitted on : Tuesday, May 11, 2021 - 3:09:40 PM
Last modification on : Tuesday, November 22, 2022 - 2:26:15 PM





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, In press, pp.neurintsurg-2020-017202. ⟨10.1136/neurintsurg-2020-017202⟩. ⟨hal-03224258⟩



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