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Head or Neck First? Speed and Rates of Reperfusion in Thrombectomy for Tandem Large Vessel Occlusion Strokes

Diogo c. Haussen 1 Francis Turjman 2 Michel Piotin 3 Julien Labreuche 4 Henrik Steglich-Arnholm 5 Markus Holtmannspötter 5 Christian Taschner 6 Sebastian Eiden 6 Raul g. Nogueira 1 Panagiotis Papanagiotou 7 Maria Boutchakova 7 Adnan h. Siddiqui 8 Bertrand Lapergue 9 Franziska Dorn 10 Christophe Cognard 11 Monika Killer 12 Salvatore Mangiafico 13 Marc Ribo 14 Marios n. Psychogios 15 Alejandro m. Spiotta 16 Marc-Antoine  Labeyrie 17 Mikael Mazighi 3, 18 Alessandra Biondi 19 Sébastien Richard 20, 21 Jonathan a. Grossberg 1 René Anxionnat 22, 23 Serge Bracard 22, 23 Benjamin Gory 22, 23 
Abstract : Background: We aim to evaluate the speed and rates of reperfusion in tandem large vessel occlusion acute stroke patients undergoing upfront cervical lesion treatment (Neck-First: angioplasty and/or stent before thrombectomy) as compared to direct intracranial occlusion therapy (Head-First) in a large international multicenter cohort. Methods: The Thrombectomy In TANdem Lesions (TITAN) collaboration pooled individual data of prospectively collected thrombectomy international databases for all consecutive anterior circulation tandem patients who underwent emergent thrombectomy. The co-primary outcome measures were rates of successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b/3) and time from groin puncture to successful reperfusion. Results: In total, 289 patients with tandem atherosclerotic etiology were included in the analysis (182 Neck-First and 107 Head-First patients). Except for differences in the Alberta Stroke Program Early CT Score (ASPECTS; median 8 [range 7–10] Neck-First vs. 7 [range 6–8] Head-First; p < 0.001) and cervical internal carotid artery (ICA) lesion severity (complete occlusion in 35% of the Neck-First vs. 57% of the Head-First patients; p < 0.001), patient characteristics were well balanced. After adjustments, there was no difference in successful reperfusion rates between the study groups (odds ratio associated with Neck-First: 1.18 [95% confidence interval, 0.60–2.17]). The time to successful reperfusion from groin puncture was significantly shorter in the Head-First group after adjustments (median 56 min [range 39–90] vs. 70 [range 50–102]; p = 0.001). No significant differences in the rates of full reperfusion, symptomatic hemorrhage, 90-day independence, or mortality were observed. Sensitivity analysis excluding patients with complete cervical ICA occlusion yielded similar results. Conclusions: The upfront approach of the intracranial lesion in patients with tandem large vessel occlusion strokes leads to similar reperfusion rates but faster reperfusion as compared to initial cervical revascularization followed by mechanical thrombectomy. Controlled studies are warranted.
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Submitted on : Wednesday, July 7, 2021 - 10:57:01 AM
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Diogo c. Haussen, Francis Turjman, Michel Piotin, Julien Labreuche, Henrik Steglich-Arnholm, et al.. Head or Neck First? Speed and Rates of Reperfusion in Thrombectomy for Tandem Large Vessel Occlusion Strokes. Interventional Neurology, 2020, 8 (2-6), pp.92-100. ⟨10.1159/000496292⟩. ⟨hal-03280223⟩



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