First-line thrombectomy strategy for anterior large vessel occlusions: results of the prospective ETIS egistry.
catheter
device
stent
stroke
thrombectomy
Journal
Journal of neurointerventional surgery
ISSN: 1759-8486
Titre abrégé: J Neurointerv Surg
Pays: England
ID NLM: 101517079
Informations de publication
Date de publication:
May 2022
May 2022
Historique:
received:
09
03
2021
revised:
28
04
2021
accepted:
29
04
2021
pubmed:
12
5
2021
medline:
15
4
2022
entrez:
11
5
2021
Statut:
ppublish
Résumé
The best recanalization strategy for mechanical thrombectomy (MT) remains unknown as no randomized controlled trial has simultaneously evaluated first-line stent retriever (SR) versus contact aspiration (CA) versus the combined approach (SR+CA). To compare the efficacy and safety profiles of SR, CA, and SR+CA in patients with acute ischemic stroke (AIS) treated by MT. We analyzed data of the Endovascular Treatment in Ischemic Stroke (ETIS) Registry, a prospective, multicenter, observational study of patients with AIS treated by MT. Patients with M1 and intracranial internal carotid artery (ICA) occlusions between January 2015 and March 2020 in 15 comprehensive stroke centers were included. We assessed the association of first-line strategy with favorable outcomes at 3 months (modified Rankin Scale score 0-2), successful recanalization rates (modified Thrombolysis In Cerebral Infarction (mTICI) 2b/3), and safety outcomes. We included 2643 patients, 406 treated with SR, 1126 with CA, and 1111 with SR+CA. CA or SR+CA achieved more successful recanalization than SR for M1 occlusions (aOR=2.09, (95% CI 1.39 to 3.13) and aOR=1.69 (95% CI 1.12 to 2.53), respectively). For intracranial ICA, SR+CA achieved more recanalization than SR (aOR=2.52 (95% CI 1.32 to 4.81)), no differences were observed between CA and SR+CA. SR+CA was associated with lower odds of favorable outcomes compared with SR (aOR=0.63 (95% CI 0.44 to 0.90)) and CA (aOR=0.71 (95% CI 0.55 to 0.92)), higher odds of mortality at 3 months (aOR=1.56 (95% CI 1.22 to 2.0)) compared with CA, and higher odds of symptomatic intracranial hemorrhage (aOR=1.59 (95% CI 1.1 to 2.3)) compared with CA. Despite high recanalization rates, our results question the safety of the combined approach, which was associated with disability and mortality. Randomized controlled trials are needed to evaluate the efficacy and safety of these techniques.
Sections du résumé
BACKGROUND
BACKGROUND
The best recanalization strategy for mechanical thrombectomy (MT) remains unknown as no randomized controlled trial has simultaneously evaluated first-line stent retriever (SR) versus contact aspiration (CA) versus the combined approach (SR+CA).
OBJECTIVE
OBJECTIVE
To compare the efficacy and safety profiles of SR, CA, and SR+CA in patients with acute ischemic stroke (AIS) treated by MT.
METHODS
METHODS
We analyzed data of the Endovascular Treatment in Ischemic Stroke (ETIS) Registry, a prospective, multicenter, observational study of patients with AIS treated by MT. Patients with M1 and intracranial internal carotid artery (ICA) occlusions between January 2015 and March 2020 in 15 comprehensive stroke centers were included. We assessed the association of first-line strategy with favorable outcomes at 3 months (modified Rankin Scale score 0-2), successful recanalization rates (modified Thrombolysis In Cerebral Infarction (mTICI) 2b/3), and safety outcomes.
RESULTS
RESULTS
We included 2643 patients, 406 treated with SR, 1126 with CA, and 1111 with SR+CA. CA or SR+CA achieved more successful recanalization than SR for M1 occlusions (aOR=2.09, (95% CI 1.39 to 3.13) and aOR=1.69 (95% CI 1.12 to 2.53), respectively). For intracranial ICA, SR+CA achieved more recanalization than SR (aOR=2.52 (95% CI 1.32 to 4.81)), no differences were observed between CA and SR+CA. SR+CA was associated with lower odds of favorable outcomes compared with SR (aOR=0.63 (95% CI 0.44 to 0.90)) and CA (aOR=0.71 (95% CI 0.55 to 0.92)), higher odds of mortality at 3 months (aOR=1.56 (95% CI 1.22 to 2.0)) compared with CA, and higher odds of symptomatic intracranial hemorrhage (aOR=1.59 (95% CI 1.1 to 2.3)) compared with CA.
CONCLUSIONS
CONCLUSIONS
Despite high recanalization rates, our results question the safety of the combined approach, which was associated with disability and mortality. Randomized controlled trials are needed to evaluate the efficacy and safety of these techniques.
Identifiants
pubmed: 33972458
pii: neurintsurg-2021-017505
doi: 10.1136/neurintsurg-2021-017505
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Investigateurs
Hocine Redjem
(H)
Simon Escalard
(S)
Jean-Philippe Desilles
(JP)
Hocine Redjem
(H)
Gabriele Ciccio
(G)
Stanislas Smajda
(S)
Robert Fahed
(R)
Mikael Obadia
(M)
Candice Sabben
(C)
Ovide Corabianu
(O)
Thomas de Broucker
(T)
Didier Smadja
(D)
Sonia Alamowitch
(S)
Olivier Ille
(O)
Eric Manchon
(E)
Pierre-Yves Garcia
(PY)
Guillaume Taylor
(G)
Malek Ben Maacha
(MB)
Frédéric Bourdain
(F)
Decroix Jean-Pierre
(D)
Adrien Wang
(A)
Serge Evrard
(S)
Maya Tchikviladze
(M)
Oguzhan Coskun
(O)
Federico Di Maria
(FD)
Georges Rodesh
(G)
Morgan Leguen
(M)
Marie Tisserand
(M)
Fernando Pico
(F)
Haja Rakotoharinandrasana
(H)
Philippe Tassan
(P)
Roxanna Poll
(R)
Florent Gariel
(F)
Xavier Barreau
(X)
Jérôme Berge
(J)
Patrice Menegon
(P)
Ludovic Lucas
(L)
Stéphane Olindo
(S)
Pauline Renou
(P)
Sharmila Sagnier
(S)
Mathilde Poli
(M)
Sabrina Debruxelles
(S)
François Rouanet
(F)
Thomas Tourdias
(T)
Jean-Sebastien Liegey
(JS)
Pierre Briau
(P)
Nicolas Pangon
(N)
Lili Detraz
(L)
Benjamin Daumas-Duport
(B)
Pierre-Louis Alexandre
(PL)
Monica Roy
(M)
Cédric Lenoble
(C)
Hubert Desal
(H)
Benoît Guillon
(B)
Solène de Gaalon
(S)
Cécile Preterre
(C)
Isabelle Costa
(I)
Serge Bracard
(S)
René Anxionnat
(R)
Marc Braun
(M)
Anne-Laure Derelle
(AL)
Romain Tonnelet
(R)
Liang Liao
(L)
François Zhu
(F)
Emmanuelle Schmitt
(E)
Sophie Planel
(S)
Lisa Humbertjean
(L)
Gioia Mione
(G)
Jean-Christophe Lacour
(JC)
Nolwenn Riou-Comte
(N)
Gabriela Hossu
(G)
Marine Beaumont
(M)
Mitchelle Bailang
(M)
Gérard Audibert
(G)
Marie Reitter
(M)
Agnès Masson
(A)
Lionel Alb
(L)
Adriana Tabarna
(A)
Marcela Voicu
(M)
Iona Podar
(I)
Madalina Brezeanu
(M)
Vincent Costalat
(V)
Grégory Gascou
(G)
Pierre-Henri Lefèvre
(PH)
Imad Derraz
(I)
Carlos Riquelme
(C)
Nicolas Gaillard
(N)
Isabelle Mourand
(I)
Lucas Corti
(L)
Jean-Christophe Ferre
(JC)
Helene Raoult
(H)
Thomas Ronziere
(T)
Maria Lassale
(M)
Fakhreddine Boustia
(F)
Jean-Yves Gauvrit
(JY)
Clément Tracol
(C)
Sophie Langnier-Lemercier
(S)
Veronica Lassalle
(V)
Cecile Malrain
(C)
Clement Tracol
(C)
Thomas Ronziere
(T)
Informations de copyright
© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.