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

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;

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.

Informations de copyright

Copyright © 2019 by S. Karger AG, Basel.

Déclaration de conflit d'intérêts

D.C.H.; F.T.; M.P.; J.L.; H.S.-A.; M.H.; C.T.; S.E.; P.P.; M.B.; A.H.S.; B.L.; F.D.; C.C.; M.K.; S.M.; M.R.; M.N.P.; A.M.S.; M.-A.L.; M.M.; A.B.; S.R.; J.A.G.; R.A.; S.B.; B.G. have nothing to disclose. R.G.N.: Stryker-Neurovacular (Trevo-2&DAWN/Trial PI), Covidien (SWIFT&SWIFT-PRIME/Steering-Committee, STAR Trial/Core-Lab), Penumbra (3-D Separator Trial/Executive-Committee).