Thrombolysis Improves Reperfusion and the Clinical Outcome in Tandem Occlusion Stroke Related to Cervical Dissection: TITAN and ETIS Pooled Analysis.
Dissection
Internal carotid artery
Reperfusion
Stroke
Thrombolytic therapy
Journal
Journal of stroke
ISSN: 2287-6391
Titre abrégé: J Stroke
Pays: Korea (South)
ID NLM: 101602023
Informations de publication
Date de publication:
09 2021
09 2021
Historique:
received:
09
12
2020
accepted:
08
09
2021
entrez:
15
10
2021
pubmed:
16
10
2021
medline:
16
10
2021
Statut:
ppublish
Résumé
Despite the widespread adoption of mechanical thrombectomy (MT) for the treatment of large vessel occlusion stroke (LVOS) in the anterior circulation, the optimal strategy for the treatment tandem occlusion related to cervical internal carotid artery (ICA) dissection is still debated. This individual patient pooled analysis investigated the safety and efficacy of prior intravenous thrombolysis (IVT) in anterior circulation tandem occlusion related to cervical ICA dissection treated with MT. We performed a retrospective analysis of two merged prospective multicenter international real-world observational registries: Endovascular Treatment in Ischemic Stroke (ETIS) and Thrombectomy In TANdem occlusions (TITAN) registries. Data from MT performed in the treatment of tandem LVOS related to cervical ICA dissection between January 2012 and December 2019 at 24 comprehensive stroke centers were analyzed. The primary endpoint was a favorable outcome defined as 90-day modified Rankin Scale (mRS) score of 0-2. The study included 144 patients with tandem occlusion LVOS due to cervical ICA dissection, of whom 94 (65.3%) received IVT before MT. Prior IVT was significantly associated with a better clinical outcome considering the mRS shift analysis (common odds ratio, 2.59; 95% confidence interval [CI], 1.35 to 4.93; P=0.004 for a 1-point improvement) and excellent outcome (90-day mRS 0-1) (adjusted odds ratio [aOR], 4.23; 95% CI, 1.60 to 11.18). IVT was also associated with a higher rate of intracranial successful reperfusion (83.0% vs. 64.0%; aOR, 2.70; 95% CI, 1.21 to 6.03) and a lower rate of symptomatic intracranial hemorrhage (4.3% vs. 14.8%; aOR, 0.21; 95% CI, 0.05 to 0.80). Prior IVT before MT for the treatment of tandem occlusion related to cervical ICA dissection was safe and associated with an improved 90-day functional outcome.
Sections du résumé
BACKGROUND AND PURPOSE
Despite the widespread adoption of mechanical thrombectomy (MT) for the treatment of large vessel occlusion stroke (LVOS) in the anterior circulation, the optimal strategy for the treatment tandem occlusion related to cervical internal carotid artery (ICA) dissection is still debated. This individual patient pooled analysis investigated the safety and efficacy of prior intravenous thrombolysis (IVT) in anterior circulation tandem occlusion related to cervical ICA dissection treated with MT.
METHODS
We performed a retrospective analysis of two merged prospective multicenter international real-world observational registries: Endovascular Treatment in Ischemic Stroke (ETIS) and Thrombectomy In TANdem occlusions (TITAN) registries. Data from MT performed in the treatment of tandem LVOS related to cervical ICA dissection between January 2012 and December 2019 at 24 comprehensive stroke centers were analyzed. The primary endpoint was a favorable outcome defined as 90-day modified Rankin Scale (mRS) score of 0-2.
RESULTS
The study included 144 patients with tandem occlusion LVOS due to cervical ICA dissection, of whom 94 (65.3%) received IVT before MT. Prior IVT was significantly associated with a better clinical outcome considering the mRS shift analysis (common odds ratio, 2.59; 95% confidence interval [CI], 1.35 to 4.93; P=0.004 for a 1-point improvement) and excellent outcome (90-day mRS 0-1) (adjusted odds ratio [aOR], 4.23; 95% CI, 1.60 to 11.18). IVT was also associated with a higher rate of intracranial successful reperfusion (83.0% vs. 64.0%; aOR, 2.70; 95% CI, 1.21 to 6.03) and a lower rate of symptomatic intracranial hemorrhage (4.3% vs. 14.8%; aOR, 0.21; 95% CI, 0.05 to 0.80).
CONCLUSIONS
Prior IVT before MT for the treatment of tandem occlusion related to cervical ICA dissection was safe and associated with an improved 90-day functional outcome.
Identifiants
pubmed: 34649385
pii: jos.2020.04889
doi: 10.5853/jos.2020.04889
pmc: PMC8521253
doi:
Types de publication
Journal Article
Langues
eng
Pagination
411-419Références
Cerebrovasc Dis. 2016;42(3-4):272-9
pubmed: 27199235
JAMA. 2021 Jan 19;325(3):234-243
pubmed: 33464335
Stroke. 2017 Sep;48(9):2450-2456
pubmed: 28747462
JAMA. 2021 Jan 19;325(3):244-253
pubmed: 33464334
Stroke. 2018 Oct;49(10):2383-2390
pubmed: 30355117
Front Neurol. 2019 Feb 19;10:102
pubmed: 30837934
Lancet Neurol. 2015 Apr;14(4):361-7
pubmed: 25684164
Lancet. 2016 Apr 23;387(10029):1723-31
pubmed: 26898852
Stroke. 2020 May;51(5):1522-1529
pubmed: 32188367
Eur J Neurol. 2012 Sep;19(9):1199-206
pubmed: 22448957
Stroke. 2017 Nov;48(11):3145-3148
pubmed: 28974628
N Engl J Med. 2020 May 21;382(21):1981-1993
pubmed: 32374959
Stroke. 2021 Jan;52(1):304-307
pubmed: 33213288
Stroke. 2020 Dec;51(12):3713-3718
pubmed: 33167809
Trials. 2021 Feb 15;22(1):141
pubmed: 33588908
J Neurol. 2015 Sep;262(9):2135-43
pubmed: 26108410
AJNR Am J Neuroradiol. 2018 Jun;39(6):1093-1099
pubmed: 29700047
Neurology. 2005 May 10;64(9):1612-4
pubmed: 15883325