Successful Thrombectomy Improves Functional Outcome in Tandem Occlusions with a Large Ischemic Core
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Gory, Benjamin | Finitsis, Stephanos Nikolaos | Desilles, Jean Philippe | Consoli, Arturo | Mazighi, Mikael | Marnat, Gaultier | Sibon, Igor | Pop, Raoul | Raposo, Nicolas | Wolff, Valérie | Cognard, Christophe H. | Richard, Sébastien | Moulin, Solène | Soize, Sébastien | Lapergue, Bertrand | Wang, Adrien | Coskun, Oguzhan | Maria, Federico | Pizzuto, Silvia | Sgreccia, Alessandro | Benoit, Charline | Gorza, Lucas | Weisenburger-Lile, David | Jabeur, Waliyde | Maia, Tchikviladze | Evrard, Serge | Rodesch, Georges L. | Blanc, Raphaël | Obadia, Michaël Alexandre | Piotin, Michel P. | Seners, Pierre | Smajda, Stanislas J. | Escalard, Simon | Maier, Benjamin | Sabben, Candice | Redjem, Hocine | Adwan, Grace | Delvoye, François | Raaisi, Amira Al | Boisseau, William | Eker, Omer Faruk | Cho, Tae-Hee | Derex, Laurent | Fontaine, Julia | Mechtouff, Laura | Nighoghossian, Norbert | Ong, Elodie | Rascle, Lucie | Riva, Roberto | Turjman, Françis | Laubacher, Morgane | Beyragued, Mehdi | 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Dargazanli, Cyril | Costalat, Vincent | Mourand, Isabelle | Arquizan, Caroline | Corti, Lucas | Schiphorst, Ter | Federico, Cagnazzo | Derraz, Imad | Mahmoudi, Mehdi | Lefevre, Pierre Henri | Gascou, Grégory | Spelle, Laurent | Caroff, Jildaz | Denier, Christian | Chalumeau, Vanessa | Mihalea, Cristian | Ozanne, Augustin P. | Ikka, Léon | Chassin, Olivier | Gallas, Sophie | Venditti, Laura | Cortese, Jonathan | Ferre, Jean Christophe | Vannier, Stéphane | Ronziere, Thomas | Veronica Lassalle, Maria | Gauvrit, Jean Yves | Tracol, Clément | Boustia, Abdelghani Fakhreddine | Malrain, Cécile | Beaufreton, Edouard | Lapotre, Thibaut | Alias, Quentin | Hissier, Julien | Guillen, Maud | Eugene, François | Chivot, Cyril | Courselle, Audrey | Ouin, Elisa | Lamy, Chantal | Delaforge, Kévin | Fernandez, Manuel | Vial, Jérémie | Laferte, Quentin | Desdoit, Xavier | Timsit, Serge | Jourdain, Aurore | Gentric, Jean Christophe | Ognard, J. | Viakhireva, Irina | Coris, Jordan | Prud'Hon, Sabine | Merrien, François Mathias | Marechal, Denis | Bruguet, Marie | Rousseau, Pierre Yves | Goas, Philippe | Boulanger, Marion | Touze, Emmanuel | Vivien, Denis | Barbier, Charlotte N. | Schneckenburger, Romain | Salaris, Fabrizio | Cogez, Julien | Guettier, Sophie | Porte, Estelle La | Bouchart, Jean | Mounayer, Charbel | Rouchaud, Aymeric M. | Saleme, Suzana | Forestier, Géraud | Clarencon, Frédéric | Rosso, Charlotte | Leder, Sara Julia | Baronnet, Flore | Crozier, Sophie | Leger, Anne | Premat, Kévin | Eimad, Shotar | Lenck, Stéphanie | Sourour, Nader Antoine | Bottin, Laure | Ghazanfari, Sam | Yger, Marion | Alamowitch, Sonia | Delorme, Stephen | Wittwer, Aymeric | Vassilev, Christine | Naggara, Olivier N. | Turc, G. | Hassen, Wagih Ben | Kerleroux, Basile | Trystram, Denis | Rodriguez-Regent, Christine | Ozkul-Wermester, Ozlem | Papagiannaki, Chrysanthi | Massardier, Evelyne Guégan | Triquenot, Aude Bagan | Lefebvre, Margaux | Burel, Julien | Viguier, Alain | Januel, Anne Christine | Albucher, Jean François | Calviere, Lionel | Darcourt, Jean | Bonneville, Fabrice | Bellanger, Guillaume | Tall, Philippe | Thalamas, Claire | Geerearts, Thomas | Grepon, Antoine Faurie | Bourdain, Frédéric D.Ric | Bernady, Patricia | Ballan, Guillaume | Bannier, Stéphanie | Ellie, Emmanuel | Flabeau, Olivier | Potenza, Julia | Soulages, Antoine | Lagoarde-Segot, Laurent | Cailliez, Hélène | Higue, David | Veunac, Louis | Lebras, Anthony | Adam, Sarah | Pegat, Benoit | Guen, Arnaud Le | Chedeville, François | Jouan, Jérémy | Demasles, Stéphanie | Richter, Johann Sebastian | Thierry Barroso, Bruno | Dahan, Camille | Gonnet, Alexis | Hubrecht, Régis | Lepine, Zoé | Castagnet, Hélène | Marasescu, Raluca | Heck, Olivier | Cuisenier, Pauline | Detante, Olivier | Wiki, Isabelle Favre | Bonaz, Clémentine | Garambois, Katia | Legris, Loïc | Kastler, Adrian | Boubagra, Kamel | Berthet, Corentin | Charara, Stéphane | Quenardelle, Véronique | Lauer, Valérie | Pierre-Paul, Irène Nora | Trzeciak, Malwina | Tuan, Hua Vi | Pagano, Paolo | Doucet, Alexandre | Gelmini, Christophe | Manceau, Pierre François | Paiusan, Laurentiu | Serre, Isabelle | Phuong Nguyen, Thi Ngoc | Sahnoun, Maher | Caucheteux, Nathalie | Ferrier, Anna | Zerroug, Abderrahim | Moreno, Ricardo | Chabert, Emmanuel | Lteif, Elie | Bourgois, Nathalie | Raquin, Marie | Pasco-Papon, Anne | Girot, Jean Baptiste | Lecluse, Aldéric | Godard, Sophie | l'Allinec, Vincent | Janot, Kévin | Bibi, Richard Edwige | Gaudron, Marie | Bretonniere, Arnaud | Annan, Mariam | Ifergan, Héloïse | Boulouis, Grégoire | Pasi, Marco | Debiais, Séverine | Molinier, Elisabeth | Wietrich, Anthony | Ruche, Valérie | Lavandier, Karine | Bejot, Yannick | Lemogne, Brivale | Ricolfi, Fédéric | Baptiste, Laura | Thouant, Pierre | Duloquin, Gauthier | Olivier Comby, Pierre | Charbonnier, Guillaume | Bonnet, Louise | Raybaud, Nicolas | Bouamra, Benjamin | Moulin, T. | Biondi, Alessandra | Olivot, Jean-Marc
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International audience.
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.
