Effect of extracranial lesion severity on outcome of endovascular thrombectomy in patients with anterior circulation tandem occlusion: analysis of the TITAN registry
Mohammad Anadani
(1)
,
Alejandro Spiotta
(1)
,
Ali Alawieh
(1)
,
Francis Turjman
(2)
,
Michel Piotin
(3)
,
Henrik Steglich-Arnholm
(4)
,
Markus Holtmannspötter
(5)
,
Christian Taschner
(6)
,
Sebastian Eiden
(4)
,
Diogo Haussen
(7)
,
Raul Nogueira
(7)
,
Panagiotis Papanagiotou
(8)
,
Maria Boutchakova
(8)
,
Adnan Siddiqui
(9)
,
Bertrand Lapergue
(10)
,
Franziska Dorn
(11)
,
Christophe Cognard
(12)
,
Monika Killer-Oberpfalzer
(13)
,
Salvatore Mangiafico
(14)
,
Marc Ribo
(15, 16)
,
Marios-Nikos Psychogios
(17)
,
Marc-Antoine Labeyrie
(18)
,
Mikael Mazighi
(3)
,
Alessandra Biondi
(19)
,
René Anxionnat
(20, 21)
,
Serge Bracard
(20, 21)
,
Sébastien Richard
(19)
,
Benjamin Gory
(20, 21)
1
MUSC -
Medical University of South Carolina [Charleston]
2 HCL - Hospices Civils de Lyon
3 Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP]
4 Rigshospitalet [Copenhagen]
5 UCPH - University of Copenhagen = Københavns Universitet
6 Albert-Ludwigs-Universität Freiburg = University of Freiburg
7 Emory University School of Medicine
8 Klinikum Bremen-Mitte
9 SUNY Buffalo - University at Buffalo [SUNY]
10 Service de neuroradiologie [Suresnes]
11 LMU - Ludwig Maximilian University [Munich] = Ludwig Maximilians Universität München
12 Service Neuroradiologie Diagnostique et Thérapeutique [CHU Toulouse]
13 PMU - Paracelsus Medizinische Privatuniversität = Paracelsus Medical University
14 AOUC - Azienda Ospedaliero Universitaria Careggi [Firenze] = Careggi University Hospital [Florence, Italy]
15 Vall d'Hebron University Hospital [Barcelona]
16 UAB - Universitat Autònoma de Barcelona = Autonomous University of Barcelona = Universidad Autónoma de Barcelona
17 UMG - University Medical Center Göttingen
18 Service de Neuroradiologie [CHU Lariboisière]
19 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
20 IADI - Imagerie Adaptative Diagnostique et Interventionnelle
21 Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy]
2 HCL - Hospices Civils de Lyon
3 Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP]
4 Rigshospitalet [Copenhagen]
5 UCPH - University of Copenhagen = Københavns Universitet
6 Albert-Ludwigs-Universität Freiburg = University of Freiburg
7 Emory University School of Medicine
8 Klinikum Bremen-Mitte
9 SUNY Buffalo - University at Buffalo [SUNY]
10 Service de neuroradiologie [Suresnes]
11 LMU - Ludwig Maximilian University [Munich] = Ludwig Maximilians Universität München
12 Service Neuroradiologie Diagnostique et Thérapeutique [CHU Toulouse]
13 PMU - Paracelsus Medizinische Privatuniversität = Paracelsus Medical University
14 AOUC - Azienda Ospedaliero Universitaria Careggi [Firenze] = Careggi University Hospital [Florence, Italy]
15 Vall d'Hebron University Hospital [Barcelona]
16 UAB - Universitat Autònoma de Barcelona = Autonomous University of Barcelona = Universidad Autónoma de Barcelona
17 UMG - University Medical Center Göttingen
18 Service de Neuroradiologie [CHU Lariboisière]
19 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
20 IADI - Imagerie Adaptative Diagnostique et Interventionnelle
21 Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy]
Mohammad Anadani
- Fonction : Auteur
- PersonId : 801468
- ORCID : 0000-0002-7813-2949
Michel Piotin
- Fonction : Auteur
- PersonId : 767048
- ORCID : 0000-0002-1354-4328
- IdRef : 104505605
Monika Killer-Oberpfalzer
- Fonction : Auteur
- PersonId : 801469
- ORCID : 0000-0001-5572-7694
Marc Ribo
- Fonction : Auteur
- PersonId : 757305
- ORCID : 0000-0001-9242-043X
Mikael Mazighi
- Fonction : Auteur
- PersonId : 786644
- ORCID : 0000-0003-0911-8999
- IdRef : 069189781
René Anxionnat
- Fonction : Auteur
- PersonId : 755707
- ORCID : 0000-0001-6112-0661
- IdRef : 075878445
Sébastien Richard
- Fonction : Auteur
- PersonId : 776166
- ORCID : 0000-0002-0945-5656
Benjamin Gory
- Fonction : Auteur
- PersonId : 762859
- ORCID : 0000-0001-8424-4464
Résumé
Introduction Endovascular treatment (EVT) for tandem occlusion (TO) of the anterior circulation is complex but effective. The effect of extracranial internal carotid artery (EICA) lesion severity on the outcomes of EVT is unknown. In this study we investigated the effect of EICA lesion severity on the outcomes of tandem occlusion EVT. Methods A multicenter retrospective TITAN (Thrombectomy In TANdem lesions) study that included 18 international endovascular capable centers was performed. Patients who received EVT for atherosclerotic TO with or without EICA lesion intervention were included. Patients were divided into two groups based on the EICA lesion severity (high-grade stenosis (≥90% North American Symptomatic Carotid Endarterectomy Trial) vs complete occlusion). Outcome measures included the 90-day clinical outcome (modified Rankin Scale score (mRS)), angiographic reperfusion (modified Thrombolysis In Cerebral Ischemia (mTICI) at the end of the procedure), procedural complications, and intracranial hemorrhage at 24 hours follow-up. Results A total of 305 patients were included in the study, of whom 135 had complete EICA occlusion and 170 had severe EICA stenosis. The EICA occlusion group had shorter mean onset-to-groin time (259±120 min vs 305±202 min; p=0.037), more patients with diabetes, and fewer with hyperlipidemia. With respect to the outcome, mTICI 2b–3 reperfusion was lower in the EICA occlusion group (70% vs 81%; p=0.03). The favorable outcome (90-day mRS 0–2), intracerebral hemorrhage and procedural complications were similar in both groups. Conclusion Atherosclerotic occlusion of the EICA in acute tandem strokes was associated with a lower rate of mTICI 2b–3 reperfusion but similar functional and safety outcomes when compared with high-grade EICA stenosis.