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Endovascular treatment for acute ischemic stroke in patients with tandem lesion in the anterior circulation: analysis from the METRICS study.
Sanak, Daniel; Kocher, Martin; Zapletalova, Jana; Cihlar, Filip; Czerny, Daniel; Cernik, David; Duras, Petr; Fiksa, Jan; Husty, Jakub; Jurak, Lubomir; Kovar, Martin; Lacman, Jiri; Padr, Radek; Prochazka, Pavel; Raupach, Jan; Reiser, Martin; Rohan, Vladimir; Roubec, Martin; Sova, Jindrich; Sercl, Miroslav; Skorna, Miroslav; Simunek, Libor; Snajdrova, Alena; Sramek, Martin; Tomek, Ales.
Afiliación
  • Sanak D; Department of Neurology, Palacký University Faculty of Medicine and University Hospital Olomouc, Olomouc, Czech Republic.
  • Kocher M; Department of Radiology, Palacký University Faculty of Medicine and University Hospital Olomouc, Olomouc, Czech Republic martin.kocher@seznam.cz.
  • Zapletalova J; Department of Biophysics and Statistics, Palacky University Olomouc, Olomouc, Czech Republic.
  • Cihlar F; Department of Radiology, Masaryk Hospital in Usti nad Labem, Usti nad Labem, Czech Republic.
  • Czerny D; Department of Radiology, University Hospital Ostrava, Ostrava, Czech Republic.
  • Cernik D; Department of Neurology, Krajska zdravotni as Masarykova nemocnice v Usti nad Labem oz, Usti nad Labem, Czech Republic.
  • Duras P; Department of Radiology, University Hospital Plzen, Plzen, Czech Republic.
  • Fiksa J; Department of Neurology, General University Hospital in Prague, Prague, Czech Republic.
  • Husty J; Department of Radiology and Nuclear Medicine, University Hospital Brno, Brno, Czech Republic.
  • Jurak L; Department of Neurology, Regional Hospital Liberec, Liberec, Czech Republic.
  • Kovar M; Department of Neurology, Na Homolce Hospital, Prague, Czech Republic.
  • Lacman J; Department of Radiology, Central Military Hospital Prague, Prague, Czech Republic.
  • Padr R; Department of Radiology, University Hospital Motol Prague, Prague, Czech Republic.
  • Prochazka P; 2nd Department of Internal Medicine, General University Hospital in Prague, Prague, Czech Republic.
  • Raupach J; Department of Radiology, Charles University Faculty of Medicine and University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.
  • Reiser M; Department of Neurology, Regional Hospital Ceske Budejovice, Ceske Budejovice, Czech Republic.
  • Rohan V; Department of Neurology, Charles University Faculty of Medicine and University Hospital Plzen, Plzen, Czech Republic.
  • Roubec M; Department of Neurology, University of Ostrava Faculty of Medicine and University Hospital Ostrava, Ostrava, Czech Republic.
  • Sova J; Department of Radiology, Regional Hospital Ceske Budejovice, Ceske Budejovice, Czech Republic.
  • Sercl M; Department of Radiology, Regional Hospital Liberec, Liberec, Czech Republic.
  • Skorna M; Department of Neurology, Masaryk University Faculty of Medicine and University Hospital Brno, Brno, Czech Republic.
  • Simunek L; Department of Neurology, Charles University Faculty of Medicine and University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.
  • Snajdrova A; Department of Radiology, Na Homolce Hospital Prague, Prague, Czech Republic.
  • Sramek M; Department of Neurology, Central Military Hospital Prague, Prague, Czech Republic.
  • Tomek A; Department of Neurology, Motol University Hospital, Praha, Praha, Czech Republic.
J Neurointerv Surg ; 15(e1): e123-e128, 2023 Sep.
Article en En | MEDLINE | ID: mdl-36002287
ABSTRACT

BACKGROUND:

Acute ischemic stroke (AIS) due to anterior circulation tandem lesion (TL) remains a technical and clinical challenge for endovascular treatment (EVT). Conflicting results from observational studies and missing evidence from the randomized trials led us to report a recent real-world multicenter clinical experience and evaluate possible predictors of good outcome after EVT.

METHODS:

We analyzed all AIS patients with TL enrolled in the prospective national study METRICS (Mechanical Thrombectomy Quality Indicators Study in Czech Stroke Centers). A good 3-month clinical outcome was scored as 0-2 points in modified Rankin Scale (mRS), achieved recanalization using the Thrombolysis In Cerebral Infarction (TICI) scale and symptomatic intracerebral hemorrhage (sICH) according to the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) criteria.

RESULTS:

Of 1178 patients enrolled in METRICS, 194 (19.2%) (59.8% males, mean age 68.7±11.5 years) were treated for TL. They did not differ in mRS 0-2 (48.7% vs 46.7%; p=0.616), mortality (17.3% vs 22.7%; p=0.103) and sICH (4.7% vs 5.1%; p=0.809) from those with single occlusion (SO). More TL patients with prior intravenous thrombolysis (IVT) reached TICI 3 (70.3% vs 50.8%; p=0.012) and mRS 0-2 (55.4% vs 34.4%; p=0.007) than those without IVT. No difference was found in the rate of sICH (6.2% vs 1.6%; p=0.276). Multivariate logistic regression analysis showed prior IVT as a predictor of mRS 0-2 after adjustment for potential confounders (OR 3.818, 95% CI 1.614 to 9.030, p=0.002).

CONCLUSION:

Patients with TL did not differ from those with SO in outcomes after EVT. TL patients with prior IVT had more complete recanalization and mRS 0-2 and IVT was found to be a predictor of good outcome after EVT.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Isquemia Encefálica / Accidente Cerebrovascular / Procedimientos Endovasculares / Accidente Cerebrovascular Isquémico Tipo de estudio: Clinical_trials / Observational_studies / Prognostic_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: J Neurointerv Surg Año: 2023 Tipo del documento: Article País de afiliación: República Checa

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Isquemia Encefálica / Accidente Cerebrovascular / Procedimientos Endovasculares / Accidente Cerebrovascular Isquémico Tipo de estudio: Clinical_trials / Observational_studies / Prognostic_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: J Neurointerv Surg Año: 2023 Tipo del documento: Article País de afiliación: República Checa