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Successful Thrombectomy Improves Functional Outcome in Tandem Occlusions with a Large Ischemic Core.
Gory, Benjamin; Finitsis, Stephanos; Desilles, Jean-Philippe; Consoli, Arturo; Mazighi, Mikael; Marnat, Gaultier; Sibon, Igor; Pop, Raoul; Raposo, Nicolas; Wolff, Valérie; Cognard, Christophe; Richard, Sébastien; Moulin, Solène; Soize, Sébastien; Lapergue, Bertrand; Olivot, Jean-Marc.
Afiliación
  • Gory B; Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, IADI, INSERM U1254, CHRU-Nancy, Nancy, France. Electronic address: benjagory@gmail.com.
  • Finitsis S; Department of Neuroradiology, Aristotle University of Thessaloniki, Ahepa Hospital, Thessaoniki, Greece.
  • Desilles JP; Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France.
  • Consoli A; Department of Diagnostic and Interventional Neuroradiology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France.
  • Mazighi M; Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France.
  • Marnat G; Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France.
  • Sibon I; Department of Neurology, Stroke Center, University Hospital of Bordeaux, Bordeaux, France.
  • Pop R; Department of Interventional Neuroradiology, University Hospital of Strasbourg, Strasbourg, France.
  • Raposo N; Department of Neurology, Acute Stroke Unit, CIC 1436-UMR 1214, CHU Toulouse, Toulouse, France.
  • Wolff V; Stroke Unit, University Hospital of Strasbourg, Strasbourg, France.
  • Cognard C; Department of Neuroradiology, CHU Toulouse, Toulouse, France.
  • Richard S; Department of Neurology, Stroke Unit, Université de Lorraine, INSERM U1116, CHRU-Nancy, Nancy, France.
  • Moulin S; Department of Neurology, Hôpital Maison Blanche, University Hospital of Reims, Université Reims Champagne-Ardenne, Reims, France.
  • Soize S; Department of Neuroradiology, Hôpital Maison Blanche, University Hospital of Reims, Université Reims Champagne-Ardenne, Reims, France.
  • Lapergue B; Department of Neurology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France.
  • Olivot JM; Department of Neurology, Acute Stroke Unit, CIC 1436-UMR 1214, CHU Toulouse, Toulouse, France.
World Neurosurg ; 178: e282-e291, 2023 Oct.
Article en En | MEDLINE | ID: mdl-37473866
BACKGROUND: Emergent stenting in tandem occlusions and mechanical thrombectomy (MT) of acute ischemic stroke related to large vessel occlusion (LVO-AIS) with a large core are tested independently. We aim to assess the impact of reperfusion with MT in patients with LVO-AIS with a large core and a tandem occlusion and to compare the safety of reperfusion between large core with tandem and nontandem occlusions in current practice. METHODS: We analyzed data of all consecutive patients included in the prospective Endovascular Treatment in Ischemic Stroke Registry in France between January 2015 and March 2023 who presented with a pretreatment ASPECTS (Alberta Stroke Program Early CT Score) of 0-5 and angiographically proven tandem occlusion. The primary end point was a favorable outcome defined by a modified Rankin Scale (mRS) score of 0-3 at 90 days. RESULTS: Among 262 included patients with a tandem occlusion and ASPECTS 0-5, 203 patients (77.5%) had a successful reperfusion (modified Thrombolysis in Cerebral Infarction grade 2b-3). Reperfused patients had a favorable shift in the overall mRS score distribution (adjusted odds ratio [aOR], 1.57 [1.22-2.03]; P < 0.001), higher rates of mRS score 0-3 (aOR, 7.03 [2.60-19.01]; P < 0.001) and mRS score 0-2 at 90 days (aOR, 3.85 [1.39-10.68]; P = 0.009) compared with nonreperfused. There was a trend between the occurrence of successful reperfusion and a decreased rate of symptomatic intracranial hemorrhage (aOR, 0.5 [0.22-1.13]; P = 0.096). Similar safety outcomes were observed after large core reperfusion in tandem and nontandem occlusions. CONCLUSIONS: Successful reperfusion was associated with a higher rate of favorable outcome in large core LVO-AIS with a tandem occlusion, with a safety profile similar to nontandem occlusion.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Isquemia Encefálica / Accidente Cerebrovascular / Procedimientos Endovasculares / Accidente Cerebrovascular Isquémico Tipo de estudio: Observational_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: World Neurosurg Asunto de la revista: NEUROCIRURGIA Año: 2023 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Isquemia Encefálica / Accidente Cerebrovascular / Procedimientos Endovasculares / Accidente Cerebrovascular Isquémico Tipo de estudio: Observational_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: World Neurosurg Asunto de la revista: NEUROCIRURGIA Año: 2023 Tipo del documento: Article Pais de publicación: Estados Unidos