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Endovascular treatment for acute ischemic stroke in patients with tandem lesion in the anterior circulation: analysis from the METRICS study
D. Sanak, M. Kocher, J. Zapletalova, F. Cihlar, D. Czerny, D. Cernik, P. Duras, J. Fiksa, J. Husty, L. Jurak, M. Kovar, J. Lacman, R. Padr, P. Prochazka, J. Raupach, M. Reiser, V. Rohan, M. Roubec, J. Sova, M. Sercl, M. Skorna, L. Simunek, A....
Jazyk angličtina Země Anglie, Velká Británie
Typ dokumentu multicentrická studie, časopisecké články
PubMed
36002287
DOI
10.1136/jnis-2022-019176
Knihovny.cz E-zdroje
- MeSH
- benchmarking MeSH
- cerebrální krvácení etiologie MeSH
- cévní mozková příhoda * diagnostické zobrazování chirurgie MeSH
- endovaskulární výkony * metody MeSH
- fibrinolytika MeSH
- ischemická cévní mozková příhoda * diagnostické zobrazování chirurgie MeSH
- ischemie mozku * diagnostické zobrazování terapie etiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- prospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- trombektomie škodlivé účinky MeSH
- trombolytická terapie metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
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.
2nd Department of Internal Medicine General University Hospital Prague Prague Czech Republic
Department of Biophysics and Statistics Palacky University Olomouc Olomouc Czech Republic
Department of Neurology Central Military Hospital Prague Prague Czech Republic
Department of Neurology General University Hospital Prague Prague Czech Republic
Department of Neurology Motol University Hospital Praha Praha Czech Republic
Department of Neurology Na Homolce Hospital Prague Czech Republic
Department of Neurology Regional Hospital Ceske Budejovice Ceske Budejovice Czech Republic
Department of Neurology Regional Hospital Liberec Liberec Czech Republic
Department of Radiology and Nuclear Medicine University Hospital Brno Brno Czech Republic
Department of Radiology Central Military Hospital Prague Prague Czech Republic
Department of Radiology Masaryk Hospital in Usti nad Labem Usti nad Labem Czech Republic
Department of Radiology Na Homolce Hospital Prague Prague Czech Republic
Department of Radiology Regional Hospital Ceske Budejovice Ceske Budejovice Czech Republic
Department of Radiology Regional Hospital Liberec Liberec Czech Republic
Department of Radiology University Hospital Motol Prague Prague Czech Republic
Department of Radiology University Hospital Ostrava Ostrava Czech Republic
Department of Radiology University Hospital Plzen Plzen Czech Republic
Citace poskytuje Crossref.org
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- $a Sanak, Daniel $u Department of Neurology, Palacký University Faculty of Medicine and University Hospital Olomouc, Olomouc, Czech Republic $1 https://orcid.org/0000000154261810 $7 xx0104413
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- $a 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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