Head or Neck First? Speed and Rates of ...
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Article dans une revue scientifique: Article original
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Title :
Head or Neck First? Speed and Rates of Reperfusion in Thrombectomy for Tandem Large Vessel Occlusion Strokes
Author(s) :
Haussen, Diogo C. [Auteur]
Emory University School of Medicine
Turjman, Francis [Auteur]
Centre Hospitalier Lyon Sud [CHU - HCL] [CHLS]
Piotin, Michel [Auteur]
Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP]
Labreuche, Julien [Auteur]
METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694
Steglich-Arnholm, Henrik [Auteur]
Rigshospitalet [Copenhagen]
Holtmannspotter, Markus [Auteur]
Rigshospitalet [Copenhagen]
Taschner, Christian [Auteur]
Universitäts Klinikum Freiburg = University Medical Center Freiburg [Uniklinik]
Eiden, Sebastian [Auteur]
Universitäts Klinikum Freiburg = University Medical Center Freiburg [Uniklinik]
Nogueira, Raul G. [Auteur]
Emory University School of Medicine
Papanagiotou, Panagiotis [Auteur]
Boutchakova, Maria [Auteur]
Siddiqui, Adnan H. [Auteur]
State University of New York at Buffalo [SUNY]
Lapergue, Bertrand [Auteur]
Hôpital Foch [Suresnes]
Dorn, Franziska [Auteur]
University-Hospital Munich-Großhadern [München]
Cognard, Christophe [Auteur]
Service Neuroradiologie Diagnostique et Thérapeutique [CHU Toulouse]
Killer, Monika [Auteur]
Paracelsus Medizinische Privatuniversität = Paracelsus Medical University [PMU]
Mangiafico, Salvatore [Auteur]
Azienda Ospedaliero Universitaria Careggi [Firenze] = Careggi University Hospital [Florence, Italy] [AOUC]
Ribo, Marc [Auteur]
Vall d'Hebron University Hospital [Barcelona]
Psychogios, Marios N. [Auteur]
University Medical Center Göttingen [UMG]
Spiotta, Alejandro M. [Auteur]
Medical University of South Carolina [Charleston] [MUSC]
Labeyrie, Marc-Antoine [Auteur]
Service de Neuroradiologie [CHU Lariboisière]
Mazighi, Mikael [Auteur]
Laboratoire de Recherche Vasculaire Translationnelle [LVTS (UMR_S_1148 / U1148)]
Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP]
Biondi, Alessandra [Auteur]
Centre Hospitalier Régional Universitaire de Besançon [CHRU Besançon]
Laboratoire de Neurosciences Intégratives et Cliniques - UFC (UR 481) [NEURO]
Richard, Sébastien [Auteur]
Défaillance Cardiovasculaire Aiguë et Chronique [DCAC]
Grossberg, Jonathan A. [Auteur]
Emory University School of Medicine
Anxionnat, René [Auteur]
Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy]
Imagerie Adaptative Diagnostique et Interventionnelle [IADI]
Bracard, Serge [Auteur]
Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy]
Imagerie Adaptative Diagnostique et Interventionnelle [IADI]
Gory, Benjamin [Auteur]
Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy]
Imagerie Adaptative Diagnostique et Interventionnelle [IADI]
TITAN, Investigators [Auteur]
Emory University School of Medicine
Turjman, Francis [Auteur]
Centre Hospitalier Lyon Sud [CHU - HCL] [CHLS]
Piotin, Michel [Auteur]
Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP]
Labreuche, Julien [Auteur]
METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694
Steglich-Arnholm, Henrik [Auteur]
Rigshospitalet [Copenhagen]
Holtmannspotter, Markus [Auteur]
Rigshospitalet [Copenhagen]
Taschner, Christian [Auteur]
Universitäts Klinikum Freiburg = University Medical Center Freiburg [Uniklinik]
Eiden, Sebastian [Auteur]
Universitäts Klinikum Freiburg = University Medical Center Freiburg [Uniklinik]
Nogueira, Raul G. [Auteur]
Emory University School of Medicine
Papanagiotou, Panagiotis [Auteur]
Boutchakova, Maria [Auteur]
Siddiqui, Adnan H. [Auteur]
State University of New York at Buffalo [SUNY]
Lapergue, Bertrand [Auteur]
Hôpital Foch [Suresnes]
Dorn, Franziska [Auteur]
University-Hospital Munich-Großhadern [München]
Cognard, Christophe [Auteur]
Service Neuroradiologie Diagnostique et Thérapeutique [CHU Toulouse]
Killer, Monika [Auteur]
Paracelsus Medizinische Privatuniversität = Paracelsus Medical University [PMU]
Mangiafico, Salvatore [Auteur]
Azienda Ospedaliero Universitaria Careggi [Firenze] = Careggi University Hospital [Florence, Italy] [AOUC]
Ribo, Marc [Auteur]
Vall d'Hebron University Hospital [Barcelona]
Psychogios, Marios N. [Auteur]
University Medical Center Göttingen [UMG]
Spiotta, Alejandro M. [Auteur]
Medical University of South Carolina [Charleston] [MUSC]
Labeyrie, Marc-Antoine [Auteur]
Service de Neuroradiologie [CHU Lariboisière]
Mazighi, Mikael [Auteur]
Laboratoire de Recherche Vasculaire Translationnelle [LVTS (UMR_S_1148 / U1148)]
Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP]
Biondi, Alessandra [Auteur]
Centre Hospitalier Régional Universitaire de Besançon [CHRU Besançon]
Laboratoire de Neurosciences Intégratives et Cliniques - UFC (UR 481) [NEURO]
Richard, Sébastien [Auteur]
Défaillance Cardiovasculaire Aiguë et Chronique [DCAC]
Grossberg, Jonathan A. [Auteur]
Emory University School of Medicine
Anxionnat, René [Auteur]
Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy]
Imagerie Adaptative Diagnostique et Interventionnelle [IADI]
Bracard, Serge [Auteur]
Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy]
Imagerie Adaptative Diagnostique et Interventionnelle [IADI]
Gory, Benjamin [Auteur]
Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy]
Imagerie Adaptative Diagnostique et Interventionnelle [IADI]
TITAN, Investigators [Auteur]
Journal title :
Interventional Neurology
Abbreviated title :
Interv. Neurol.
Volume number :
8
Pages :
92-100
Publication date :
2020-02-11
ISSN :
1664-9737
English keyword(s) :
Carotid artery
Thrombectomy
Stroke
Thrombectomy
Stroke
HAL domain(s) :
Sciences du Vivant [q-bio]
English abstract : [en]
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) ...
Show more >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; p < 0.001) and cervical internal carotid artery (ICA) lesion severity (complete occlusion in 35% of the Neck-First vs. 57% of the Head-First patients; p < 0.001), patient characteristics were well balanced. After adjustments, there was no difference in successful reperfusion rates between the study groups (odds ratio associated with Neck-First: 1.18 [95% confidence interval, 0.60–2.17]). The time to successful reperfusion from groin puncture was significantly shorter in the Head-First group after adjustments (median 56 min [range 39–90] vs. 70 [range 50–102]; p = 0.001). No significant differences in the rates of full reperfusion, symptomatic hemorrhage, 90-day independence, or mortality were observed. Sensitivity analysis excluding patients with complete cervical ICA occlusion yielded similar results. 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.Show less >
Show more >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; p < 0.001) and cervical internal carotid artery (ICA) lesion severity (complete occlusion in 35% of the Neck-First vs. 57% of the Head-First patients; p < 0.001), patient characteristics were well balanced. After adjustments, there was no difference in successful reperfusion rates between the study groups (odds ratio associated with Neck-First: 1.18 [95% confidence interval, 0.60–2.17]). The time to successful reperfusion from groin puncture was significantly shorter in the Head-First group after adjustments (median 56 min [range 39–90] vs. 70 [range 50–102]; p = 0.001). No significant differences in the rates of full reperfusion, symptomatic hemorrhage, 90-day independence, or mortality were observed. Sensitivity analysis excluding patients with complete cervical ICA occlusion yielded similar results. 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.Show less >
Language :
Anglais
Audience :
Internationale
Popular science :
Non
Administrative institution(s) :
Université de Lille
CHU Lille
CHU Lille
Submission date :
2023-11-15T08:43:52Z
2023-12-11T15:16:42Z
2023-12-11T15:16:42Z