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)
1
Emory University [Atlanta, GA]
2 HCL - Hospices Civils de Lyon
3 Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP]
4 METRICS - Evaluation des technologies de santé et des pratiques médicales - ULR 2694
5 Rigshospitalet [Copenhagen]
6 Uniklinik - Universitäts Klinikum Freiburg = University Medical Center Freiburg
7 Klinikum Bremen-Mitte
8 SUNY - State University of New York
9 Hôpital Foch [Suresnes]
10 University-Hospital Munich-Großhadern [München]
11 Service Neuroradiologie Diagnostique et Thérapeutique [CHU Toulouse]
12 PMU - Paracelsus Medizinische Privatuniversität = Paracelsus Medical University
13 AOUC - Azienda Ospedaliero-Universitaria Careggi [Firenze]
14 Vall d'Hebron University Hospital [Barcelona]
15 UMG - University Medical Center Göttingen
16 MUSC - Medical University of South Carolina [Charleston]
17 Service de Neuroradiologie [CHU Lariboisière]
18 LVTS (UMR_S_1148 / U1148) - Laboratoire de Recherche Vasculaire Translationnelle
19 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
20 Service de neurologie [CHRU Nancy]
21 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
22 IADI - Imagerie Adaptative Diagnostique et Interventionnelle
23 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 METRICS - Evaluation des technologies de santé et des pratiques médicales - ULR 2694
5 Rigshospitalet [Copenhagen]
6 Uniklinik - Universitäts Klinikum Freiburg = University Medical Center Freiburg
7 Klinikum Bremen-Mitte
8 SUNY - State University of New York
9 Hôpital Foch [Suresnes]
10 University-Hospital Munich-Großhadern [München]
11 Service Neuroradiologie Diagnostique et Thérapeutique [CHU Toulouse]
12 PMU - Paracelsus Medizinische Privatuniversität = Paracelsus Medical University
13 AOUC - Azienda Ospedaliero-Universitaria Careggi [Firenze]
14 Vall d'Hebron University Hospital [Barcelona]
15 UMG - University Medical Center Göttingen
16 MUSC - Medical University of South Carolina [Charleston]
17 Service de Neuroradiologie [CHU Lariboisière]
18 LVTS (UMR_S_1148 / U1148) - Laboratoire de Recherche Vasculaire Translationnelle
19 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
20 Service de neurologie [CHRU Nancy]
21 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
22 IADI - Imagerie Adaptative Diagnostique et Interventionnelle
23 Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy]
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
Sébastien Richard
- Function : Author
- PersonId : 776166
- ORCID : 0000-0002-0945-5656
René Anxionnat
- Function : Author
- PersonId : 755707
- ORCID : 0000-0001-6112-0661
- IdRef : 075878445
Benjamin Gory
- Function : Author
- PersonId : 762859
- ORCID : 0000-0001-8424-4464
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.