J Stroke.  2021 Sep;23(3):411-419. 10.5853/jos.2020.04889.

Thrombolysis Improves Reperfusion and the Clinical Outcome in Tandem Occlusion Stroke Related to Cervical Dissection: TITAN and ETIS Pooled Analysis

• Marnat G
• Sibon I
• Bourcier R
• Anadani M
• Gariel F
• Labreuche J
• Kyheng M
• Mazighi M
• Dargazanli C
• Piotin M
• Consoli A
• Blanc R
• Anxionnat R
• Audibert G
• Richard S
• Lapergue B
• Gory B
• on Behalf of ETIS and TITAN Investigators

• KMID: 2520918
• DOI: http://doi.org/10.5853/jos.2020.04889

Abstract

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.

Keyword

Stroke; Internal carotid artery; Dissection; Reperfusion; Thrombolytic therapy

Figure

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  Figure 1. Flowchart. MT, mechanical thrombectomy; IVT, intravenous thrombolysis.

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  Figure 2. Distribution of 90-day modified Rankin Scale (mRS) scores according to use or not of intravenous thrombolysis (IVT) prior endovascular treatment. Common odds ratio (cOR) indicates for 1-point improvement in 90-day mRS score (after combining 5 and 6 together). CI, confidence interval.

Reference

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