• World Neurosurg · Oct 2023

    Successful thrombectomy improves functional outcome in tandem occlusions with a large ischemic core.

    • Benjamin Gory, Stephanos Finitsis, Jean-Philippe Desilles, Arturo Consoli, Mikael Mazighi, Gaultier Marnat, Igor Sibon, Raoul Pop, Nicolas Raposo, Valérie Wolff, Christophe Cognard, Sébastien Richard, Solène Moulin, Sébastien Soize, Bertrand Lapergue, Jean-Marc Olivot, and ETIS Registry Investigators.
    • Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, IADI, INSERM U1254, CHRU-Nancy, Nancy, France. Electronic address: benjagory@gmail.com.
    • World Neurosurg. 2023 Oct 1; 178: e282e291e282-e291.

    BackgroundEmergent 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.MethodsWe 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.ResultsAmong 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.ConclusionsSuccessful 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.Copyright © 2023 Elsevier Inc. All rights reserved.

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