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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 
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.
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Submitted on : Wednesday, June 23, 2021 - 1:53:20 PM
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Mohammad Anadani, Alejandro Spiotta, Ali Alawieh, Francis Turjman, Michel Piotin, et al.. Emergent Carotid Stenting Plus Thrombectomy After Thrombolysis in Tandem Strokes. Stroke, American Heart Association, 2019, 50 (8), pp.2250-2252. ⟨10.1161/STROKEAHA.118.024733⟩. ⟨hal-03268700⟩



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