Successful Thrombectomy Improves Functional Outcome in Tandem Occlusions with a Large Ischemic Core.

Outcome; Reperfusion; Safety; Stroke; Tandem occlusion; Thrombectomy; Humans; Prospective Studies; Treatment Outcome; Retrospective Studies; Brain Ischemia/surgery; Brain Ischemia/complications; Ischemic Stroke/complications; Stroke/therapy; Endovascular Procedures; Brain Ischemia; Ischemic Stroke; Surgery; Neurology (clinical)

Abstract :

[en] [en] 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.

Disciplines :

Neurology

Author, co-author :

Gory, Benjamin; Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, IADI, INSERM U1254, CHRU-Nancy, Nancy, France. Electronic address: benjagory@gmail.com

Finitsis, Stephanos; Department of Neuroradiology, Aristotle University of Thessaloniki, Ahepa Hospital, Thessaoniki, Greece

Desilles, Jean-Philippe; Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France

Consoli, Arturo; Department of Diagnostic and Interventional Neuroradiology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France

Mazighi, Mikael; Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France

Marnat, Gaultier; Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France

Sibon, Igor; Department of Neurology, Stroke Center, University Hospital of Bordeaux, Bordeaux, France

Pop, Raoul; Department of Interventional Neuroradiology, University Hospital of Strasbourg, Strasbourg, France

Raposo, Nicolas; Department of Neurology, Acute Stroke Unit, CIC 1436-UMR 1214, CHU Toulouse, Toulouse, France

Wolff, Valérie; Stroke Unit, University Hospital of Strasbourg, Strasbourg, France

More authors (7 more)

Other collaborator :

Delvoye, François ; Université de Liège - ULiège > Département des sciences cliniques

Language :

English

Title :

Successful Thrombectomy Improves Functional Outcome in Tandem Occlusions with a Large Ischemic Core.

Publication date :

October 2023

Journal title :

World Neurosurgery

ISSN :

1878-8750

eISSN :

1878-8769

Publisher :

Elsevier, United States

Volume :

178

Pages :

e282 - e291

Peer reviewed :

Peer Reviewed verified by ORBi

Additional URL :

https://api.elsevier.com/content/article/PII:S187887502300966X?httpAccept=text/xml

Funding text :

Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Available on ORBi :

since 20 January 2025

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