Emergent Carotid Stenting Plus Thrombectomy After Thrombolysis in Tandem Strokes
Mohammad Anadani
(1)
,
Alejandro Spiotta
(1)
,
Ali Alawieh
(1)
,
Francis Turjman
(2)
,
Michel Piotin
(3)
,
Diogo Haussen
(4)
,
Raul Nogueira
(4)
,
Panagiotis Papanagiotou
(5)
,
Adnan Siddiqui
(6)
,
Bertrand Lapergue
(7)
,
Franziska Dorn
(8)
,
Christophe Cognard
(9)
,
Marc Ribo
(10)
,
Marios Psychogios
(11)
,
Marc Antoine Labeyrie
(12)
,
Mikael Mazighi
(3)
,
Alessandra Biondi
(13)
,
René Anxionnat
(14, 15)
,
Serge Bracard
(14, 15)
,
Sébastien Richard
(16, 17)
,
Benjamin Gory
(14, 15)
,
Jonathan Andrew Grossberg
,
Adrien Guenego
,
Julien Darcourt
,
Isabelle Vukasinovic
,
Elisa Pomero
,
Jason Davies
,
Leonardo Renieri
,
Corentin Hecker
,
Maria Muchada Muchada
,
Arturo Consoli
(14, 7)
,
Georges Rodesch
,
Emmanuel Houdart
,
Raymond Turner
,
Aquilla Turk
,
Imran Chaudry
,
Johanna Lockau
,
Andreas Kastrup
,
Raphaël Blanc
,
Hocine Redjem
,
Daniel Behme
,
Hussain Shallwani
,
Maurer Christopher
,
Gioia Mione
,
Lisa Humbertjean
,
Jean-Christophe Lacour
,
François Zhu
(14)
,
Anne-Laure Derelle
,
Romain Tonnelet
,
Liang Liao
1
MUSC -
Medical University of South Carolina [Charleston]
2 Département de Neuroradiologie [Centre Hospitalier Lyon Sud - HCL]
3 Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP]
4 Emory University School of Medicine
5 Klinikum Bremen-Mitte
6 SUNY Buffalo - University at Buffalo [SUNY]
7 Hôpital Foch [Suresnes]
8 Klinikum der Universität [München]
9 Service Neuroradiologie Diagnostique et Thérapeutique [CHU Toulouse]
10 Vall d'Hebron University Hospital [Barcelona]
11 UMG - University Medical Center Göttingen
12 Service de Neuroradiologie [CHU Lariboisière]
13 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
14 IADI - Imagerie Adaptative Diagnostique et Interventionnelle
15 Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy]
16 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
17 Service de neurologie [CHRU Nancy]
2 Département de Neuroradiologie [Centre Hospitalier Lyon Sud - HCL]
3 Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP]
4 Emory University School of Medicine
5 Klinikum Bremen-Mitte
6 SUNY Buffalo - University at Buffalo [SUNY]
7 Hôpital Foch [Suresnes]
8 Klinikum der Universität [München]
9 Service Neuroradiologie Diagnostique et Thérapeutique [CHU Toulouse]
10 Vall d'Hebron University Hospital [Barcelona]
11 UMG - University Medical Center Göttingen
12 Service de Neuroradiologie [CHU Lariboisière]
13 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
14 IADI - Imagerie Adaptative Diagnostique et Interventionnelle
15 Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy]
16 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
17 Service de neurologie [CHRU Nancy]
Mohammad Anadani
- Function : Author
- PersonId : 801468
- ORCID : 0000-0002-7813-2949
Michel Piotin
- Function : Author
- PersonId : 767048
- ORCID : 0000-0002-1354-4328
- IdRef : 104505605
Marc Ribo
- Function : Author
- PersonId : 757305
- ORCID : 0000-0001-9242-043X
Mikael Mazighi
- Function : Author
- PersonId : 786644
- ORCID : 0000-0003-0911-8999
- IdRef : 069189781
René Anxionnat
- Function : Author
- PersonId : 755707
- ORCID : 0000-0001-6112-0661
- IdRef : 075878445
Sébastien Richard
- Function : Author
- PersonId : 776166
- ORCID : 0000-0002-0945-5656
Benjamin Gory
- Function : Author
- PersonId : 762859
- ORCID : 0000-0001-8424-4464
Jonathan Andrew Grossberg
- Function : Author
Adrien Guenego
- Function : Author
Julien Darcourt
- Function : Author
Isabelle Vukasinovic
- Function : Author
Elisa Pomero
- Function : Author
Jason Davies
- Function : Author
Leonardo Renieri
- Function : Author
Corentin Hecker
- Function : Author
Maria Muchada Muchada
- Function : Author
Arturo Consoli
- Function : Author
- PersonId : 786640
- ORCID : 0000-0001-6640-8541
Georges Rodesch
- Function : Author
Emmanuel Houdart
- Function : Author
Raymond Turner
- Function : Author
Aquilla Turk
- Function : Author
Imran Chaudry
- Function : Author
Johanna Lockau
- Function : Author
Andreas Kastrup
- Function : Author
Raphaël Blanc
- Function : Author
Hocine Redjem
- Function : Author
- PersonId : 779240
- ORCID : 0000-0002-6943-9922
Daniel Behme
- Function : Author
Hussain Shallwani
- Function : Author
Maurer Christopher
- Function : Author
Gioia Mione
- Function : Author
Lisa Humbertjean
- Function : Author
Jean-Christophe Lacour
- Function : Author
François Zhu
- Function : Author
- PersonId : 1376787
- IdHAL : francois-zhu
Anne-Laure Derelle
- Function : Author
Romain Tonnelet
- Function : Author
Liang Liao
- Function : Author
Abstract
Background and Purpose— Emergent carotid artery stenting plus mechanical thrombectomy is an effective treatment for acute ischemic stroke patients with tandem occlusion of the anterior circulation. However, there is limited data supporting the safety of this approach in patients treated with prior intravenous thrombolysis (IVT). We aimed to investigate the safety of emergent carotid artery stenting-mechanical thrombectomy approach in stroke patient population treated with prior IVT. Methods— We assessed patients with acute ischemic stroke because of atherosclerotic tandem occlusion that were treated with emergent carotid artery stenting-mechanical thrombectomy approach from the multicenter observational Thrombectomy in Tandem Lesions registry. Patients were divided into 2 groups based on pretreatment IVT (IVT versus no-IVT). Intracerebral hemorrhages were classified according to the European Cooperative Acute Stroke Study II criteria. Results— Among 205 patients included in the present study, 125 (60%) received prior IVT. Time from symptoms onset-to-groin puncture was shorter (234±100 versus 256±234 minutes; P =0.002), and heparin use was less in the IVT group (14% versus 35%; P <0.001); otherwise, there was no difference in the baseline characteristics. There was no significant difference between the IVT and no-IVT groups in the rate of symptomatic intracerebral hemorrhage (5% versus 8%; P =0.544), parenchymal hematoma type 1 to 2 (15% versus 18%; P =0.647), successful reperfusion (modified Thrombolysis in Cerebral Ischemia 2b–3), or 90-day favorable outcome (modified Rankin Scale score of 0–2 at 90 days). The 90-day all-cause mortality rate was significantly lower in the IVT group (8% versus 20%; P =0.017). After adjusting for covariates, IVT was not associated with symptomatic intracerebral hemorrhage or 90-day mortality. Conclusions— Emergent carotid artery stenting-mechanical thrombectomy approach was not associated with an increased risk of hemorrhagic complications in tandem occlusion patients who received IVT before the intervention.