Emergent Management of Tandem Lesions in Acute Ischemic Stroke

Ashutosh P. Jadhav, Osama O. Zaidat, David S. Liebeskind, Dileep R Yavagal, Diogo C. Haussen, Frank R. Hellinger, Reza Jahan, Mouhammad A. Jumaa, Viktor Szeder, Raul G. Nogueira, Tudor G. Jovin

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background and Purpose- Although intracranial thrombectomy represents the standard treatment approach for anterior circulation tandem occlusions, whether the extracranial lesion requires acute stenting remains unclear. Our aim was to investigate differences in clinical and procedural outcomes related to stenting extracranial lesions in a registry of patients undergoing thrombectomy for acute stroke. Methods- Data were analyzed from the STRATIS registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke)-a prospective, nonrandomized study of patients undergoing neurothrombectomy with the Solitaire device. A total of 984 patients treated at 55 sites were analyzed. Univariate and multivariable logistic regression was used to assess relationship between outcome and procedural technique. Results- Of 147 (14.9%) patients with tandem lesions treated, stenting of the extracranial lesion during thrombectomy was performed in 80 patients and withheld in 67 patients. There were no differences between groups with respect to age, ASPECTS (Alberta Stroke Program Early CT Score), or intravenous-tPA (tissue-type plasminogen activator) use. However, the patients in the stenting group had lower baseline National Institutes of Health Stroke Scale (16 versus 17.9; P=0.07), shorter onset to arterial puncture time (133.6 versus 163.4 minutes; P=0.04), and lower rates of atrial fibrillation (6.3% versus 25.4%) as compared to the nonstenting group. Good outcomes (modified Rankin Scale, 0-2 at 90 days) were higher in the stenting group (68.5% versus 42.2%; P=0.003) with no difference in mortality or symptomatic hemorrhage. After adjustment for covariates, stenting continued to be associated with superior outcomes. Conclusions- Acute stenting of an extracranial carotid stenosis during neurothrombectomy can be achieved with equal safety compared with no stenting. Carotid stenting in the acute phase may lead to better outcomes; this should ideally be confirmed by randomized trials.

Original languageEnglish (US)
Pages (from-to)428-433
Number of pages6
JournalStroke
Volume50
Issue number2
DOIs
StatePublished - Feb 1 2019

Fingerprint

Stroke
Thrombectomy
Registries
Equipment and Supplies
Alberta
Carotid Stenosis
National Institutes of Health (U.S.)
Tissue Plasminogen Activator
Punctures
Atrial Fibrillation
Logistic Models
Prospective Studies
Hemorrhage
Safety
Mortality

Keywords

  • atrial fibrillation
  • carotid stenosis
  • intracerebral hemorrhage
  • stent
  • stroke
  • thrombectomy

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Jadhav, A. P., Zaidat, O. O., Liebeskind, D. S., Yavagal, D. R., Haussen, D. C., Hellinger, F. R., ... Jovin, T. G. (2019). Emergent Management of Tandem Lesions in Acute Ischemic Stroke. Stroke, 50(2), 428-433. https://doi.org/10.1161/STROKEAHA.118.021893

Emergent Management of Tandem Lesions in Acute Ischemic Stroke. / Jadhav, Ashutosh P.; Zaidat, Osama O.; Liebeskind, David S.; Yavagal, Dileep R; Haussen, Diogo C.; Hellinger, Frank R.; Jahan, Reza; Jumaa, Mouhammad A.; Szeder, Viktor; Nogueira, Raul G.; Jovin, Tudor G.

In: Stroke, Vol. 50, No. 2, 01.02.2019, p. 428-433.

Research output: Contribution to journalArticle

Jadhav, AP, Zaidat, OO, Liebeskind, DS, Yavagal, DR, Haussen, DC, Hellinger, FR, Jahan, R, Jumaa, MA, Szeder, V, Nogueira, RG & Jovin, TG 2019, 'Emergent Management of Tandem Lesions in Acute Ischemic Stroke', Stroke, vol. 50, no. 2, pp. 428-433. https://doi.org/10.1161/STROKEAHA.118.021893
Jadhav AP, Zaidat OO, Liebeskind DS, Yavagal DR, Haussen DC, Hellinger FR et al. Emergent Management of Tandem Lesions in Acute Ischemic Stroke. Stroke. 2019 Feb 1;50(2):428-433. https://doi.org/10.1161/STROKEAHA.118.021893
Jadhav, Ashutosh P. ; Zaidat, Osama O. ; Liebeskind, David S. ; Yavagal, Dileep R ; Haussen, Diogo C. ; Hellinger, Frank R. ; Jahan, Reza ; Jumaa, Mouhammad A. ; Szeder, Viktor ; Nogueira, Raul G. ; Jovin, Tudor G. / Emergent Management of Tandem Lesions in Acute Ischemic Stroke. In: Stroke. 2019 ; Vol. 50, No. 2. pp. 428-433.
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abstract = "Background and Purpose- Although intracranial thrombectomy represents the standard treatment approach for anterior circulation tandem occlusions, whether the extracranial lesion requires acute stenting remains unclear. Our aim was to investigate differences in clinical and procedural outcomes related to stenting extracranial lesions in a registry of patients undergoing thrombectomy for acute stroke. Methods- Data were analyzed from the STRATIS registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke)-a prospective, nonrandomized study of patients undergoing neurothrombectomy with the Solitaire device. A total of 984 patients treated at 55 sites were analyzed. Univariate and multivariable logistic regression was used to assess relationship between outcome and procedural technique. Results- Of 147 (14.9{\%}) patients with tandem lesions treated, stenting of the extracranial lesion during thrombectomy was performed in 80 patients and withheld in 67 patients. There were no differences between groups with respect to age, ASPECTS (Alberta Stroke Program Early CT Score), or intravenous-tPA (tissue-type plasminogen activator) use. However, the patients in the stenting group had lower baseline National Institutes of Health Stroke Scale (16 versus 17.9; P=0.07), shorter onset to arterial puncture time (133.6 versus 163.4 minutes; P=0.04), and lower rates of atrial fibrillation (6.3{\%} versus 25.4{\%}) as compared to the nonstenting group. Good outcomes (modified Rankin Scale, 0-2 at 90 days) were higher in the stenting group (68.5{\%} versus 42.2{\%}; P=0.003) with no difference in mortality or symptomatic hemorrhage. After adjustment for covariates, stenting continued to be associated with superior outcomes. Conclusions- Acute stenting of an extracranial carotid stenosis during neurothrombectomy can be achieved with equal safety compared with no stenting. Carotid stenting in the acute phase may lead to better outcomes; this should ideally be confirmed by randomized trials.",
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AU - Liebeskind, David S.

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AU - Haussen, Diogo C.

AU - Hellinger, Frank R.

AU - Jahan, Reza

AU - Jumaa, Mouhammad A.

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