1.Susceptibility Vessel Sign in the ASTER Trial: Higher Recanalization Rate and More Favourable Clinical Outcome after First Line Stent Retriever Compared to Contact Aspiration.
Romain BOURCIER ; Mickael MAZIGHI ; Julien LABREUCHE ; Robert FAHED ; Raphael BLANC ; Benjamin GORY ; Alain DUHAMEL ; Gaultier MARNAT ; Suzana SALEME ; Vincent COSTALAT ; Serge BRACARD ; Hubert DESAL ; Arturo CONSOLI ; Michel PIOTIN ; Bertrand LAPERGUE
Journal of Stroke 2018;20(2):268-276
BACKGROUND AND PURPOSE: In the Aspiration vs. Stent Retriever for Successful Revascularization (ASTER) trial, which evaluated contact aspiration (CA) versus stent retriever (SR) use as first-line technique, the impact of the susceptibility vessel sign (SVS) on magnetic resonance imaging (MRI) was studied to determine its influence on trial results. METHODS: We included patients having undergone CA or SR for M1 or M2 occlusions, who were screened by MRI with T2* gradient recalled echo. Occlusions were classified as SVS (+) or SVS (–) in each randomization arm. Modified thrombolysis in cerebral infarction (mTICI) 2b, 2c, or 3 revascularization rates were recorded and clinical outcomes assessed by the overall distribution of modified Rankin scale (mRS) at 90 days. RESULTS: Among the 202 patients included, 143 patients were SVS (+) (70.8%; 95% confidence interval [CI], 64.5% to 77.1%). Overall, there was no difference in angiographic and clinical outcomes according to SVS status. However, compared to SR, CA achieved a lower mTICI 2c/3 rate in SVS (+) patients (risk ratio [RR] for CA vs. SR, 0.60; 95% CI, 0.51 to 0.71) but not in SVS (–) (RR, 1.11; 95% CI, 0.69 to 1.77; P for interaction=0.018). A significant heterogeneity in favor of superiority of first-line SR strategy in SVS (+) patients was also found regarding the overall mRS distribution (common odds ratio for CA vs. SR, 0.40 vs. 1.32; 95% CI, 0.21 to 0.74 in SVS (+) vs. 95% CI, 0.51 to 3.35 in SVS (–); P for interaction=0.038). CONCLUSIONS: As a first line strategy, SR achieved higher recanalization rates and a more favourable clinical outcome at 3 months compared to CA when MRI shows SVS within the thrombus.
Arm
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Cerebral Infarction
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Humans
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Magnetic Resonance Imaging
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Odds Ratio
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Population Characteristics
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Random Allocation
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Stents*
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Thrombectomy
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Thrombosis
2.Erratum: Susceptibility Vessel Sign in the ASTER Trial: Higher Recanalization Rate and More Favourable Clinical Outcome after First Line Stent Retriever Compared to Contact Aspiration.
Romain BOURCIER ; Mickael MAZIGHI ; Julien LABREUCHE ; Robert FAHED ; Raphael BLANC ; Benjamin GORY ; Alain DUHAMEL ; Gaultier MARNAT ; Suzana SALEME ; Vincent COSTALAT ; Serge BRACARD ; Hubert DESAL ; Arturo CONSOLI ; Michel PIOTIN ; Bertrand LAPERGUE
Journal of Stroke 2018;20(3):416-416
On page 271, in Table 1, the value ‘1115 (65??51)’ of subgroup ‘Imaging to groin puncture’ and column heading ‘SVS (??’ was input incorrectly. The correct value is ‘115 (65??51).’
3.Thrombolysis Improves Reperfusion and the Clinical Outcome in Tandem Occlusion Stroke Related to Cervical Dissection: TITAN and ETIS Pooled Analysis
Gaultier MARNAT ; Igor SIBON ; Romain BOURCIER ; Mohammad ANADANI ; Florent GARIEL ; Julien LABREUCHE ; Maeva KYHENG ; Mikael MAZIGHI ; Cyril DARGAZANLI ; Michel PIOTIN ; Arturo CONSOLI ; Raphaël BLANC ; René ANXIONNAT ; Gérard AUDIBERT ; Sébastien RICHARD ; Bertrand LAPERGUE ; Benjamin GORY ;
Journal of Stroke 2021;23(3):411-419
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.
4.Thrombolysis Improves Reperfusion and the Clinical Outcome in Tandem Occlusion Stroke Related to Cervical Dissection: TITAN and ETIS Pooled Analysis
Gaultier MARNAT ; Igor SIBON ; Romain BOURCIER ; Mohammad ANADANI ; Florent GARIEL ; Julien LABREUCHE ; Maeva KYHENG ; Mikael MAZIGHI ; Cyril DARGAZANLI ; Michel PIOTIN ; Arturo CONSOLI ; Raphaël BLANC ; René ANXIONNAT ; Gérard AUDIBERT ; Sébastien RICHARD ; Bertrand LAPERGUE ; Benjamin GORY ;
Journal of Stroke 2021;23(3):411-419
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.
5.Recanalization before Thrombectomy in Tenecteplase vs. Alteplase-Treated Drip-and-Ship Patients
Pierre SENERS ; Jildaz CAROFF ; Nicolas CHAUSSON ; Guillaume TURC ; Christian DENIER ; Michel PIOTIN ; Manvel AGHASARYAN ; Cosmin ALECU ; Olivier CHASSIN ; Bertrand LAPERGUE ; Olivier NAGGARA ; Marc FERRIGNO ; Caroline ARQUIZAN ; Tae Hee CHO ; Ana Paula NARATA ; Sébastien RICHARD ; Nicolas BRICOUT ; Mikaël MAZIGHI ; Vincent COSTALAT ; Benjamin GORY ; Séverine DEBIAIS ; Arturo CONSOLI ; Serge BRACARD ; Catherine OPPENHEIM ; Jean Louis MAS ; Didier SMADJA ; Laurent SPELLE ; Jean Claude BARON
Journal of Stroke 2019;21(1):105-107
No abstract available.
Humans
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Thrombectomy