1
|
Sgreccia A, Desilles JP, Costalat V, Dargazanli C, Bourcier R, Tessier G, Rouchaud A, Saleme S, Spelle L, Caroff J, Marnat G, Barreau X, Clarençon F, Shotar E, Eugene F, Houdart E, Gory B, Zhu F, Labreuche J, Piotin M, Lapergue B, Consoli A. Combined Technique for Internal Carotid Artery Terminus or Middle Cerebral Artery Occlusions in the ASTER2 Trial. Stroke 2024; 55:376-384. [PMID: 38126181 DOI: 10.1161/strokeaha.123.045227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The aim of this study was to report the results of a subgroup analysis of the ASTER2 trial (Effect of Thrombectomy With Combined Contact Aspiration and Stent Retriever vs Stent Retriever Alone on Revascularization in Patients With Acute Ischemic Stroke and Large Vessel Occlusion) comparing the safety and efficacy of the combined technique (CoT) and stent retriever as a first-line approach in internal carotid artery (ICA) terminus±M1-middle cerebral artery (M1-MCA) and isolated M1-MCA occlusions. METHODS Patients enrolled in the ASTER2 trial with ICA terminus±M1-MCA and isolated M1-MCA occlusions were included in this subgroup analysis. The effect of first-line CoT versus stent retriever according to the occlusion site was assessed on angiographic (first-pass effect, expanded Treatment in Cerebral Infarction score ≥2b50, and expanded Treatment in Cerebral Infarction score ≥2c grades at the end of the first-line strategy and at the end of the procedure) and clinicoradiological outcomes (24-hour National Institutes of Health Stroke Scale, ECASS-III [European Cooperative Acute Stroke Study] grades, and 3-month modified Rankin Scale). RESULTS Three hundred sixty-two patients were included in the postsubgroup analysis according to the occlusion site: 299 were treated for isolated M1-MCA occlusion (150 with first-line CoT) and 63 were treated for ICA terminus±M1-MCA occlusion (30 with first-line CoT). Expanded Treatment in Cerebral Infarction score ≥2b50 (odds ratio, 11.83 [95% CI, 2.32-60.12]) and expanded Treatment in Cerebral Infarction score ≥2c (odds ratio, 4.09 [95% CI, 1.39-11.94]) were significantly higher in first-line CoT compared with first-line stent retriever in patients with ICA terminus±M1-MCA occlusion but not in patients with isolated M1-MCA. CONCLUSIONS First-line CoT was associated with higher reperfusion grades in patients with ICA terminus±M1-MCA at the end of the procedure. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03290885.
Collapse
Affiliation(s)
- Alessandro Sgreccia
- Diagnostic and Interventional Neuroradiology, Foch Hospital, Suresnes, France (A.S., B.L., A.C.)
| | - Jean-Philippe Desilles
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (J.-P.D., M.P.)
| | - Vincent Costalat
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, France (V.C., C.D.)
| | - Cyril Dargazanli
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, France (V.C., C.D.)
| | - Romain Bourcier
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nantes, France (R.B., G.T.)
| | - Guillaume Tessier
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nantes, France (R.B., G.T.)
| | - Aymeric Rouchaud
- Interventional Neuroradiology Department, Centre Hospitalier Universitaire Limoges, France (A.R., S.S.)
| | - Suzana Saleme
- Interventional Neuroradiology Department, Centre Hospitalier Universitaire Limoges, France (A.R., S.S.)
| | - Laurent Spelle
- Interventional Neuroradiology Department, Kremlin Bicêtre Hospital, France (L.S., J.C.)
| | - Jildaz Caroff
- Interventional Neuroradiology Department, Kremlin Bicêtre Hospital, France (L.S., J.C.)
| | - Gaultier Marnat
- Interventional Neuroradiology Department, Centre Hospitalier Régional Universitaire Bordeaux, France (G.M., X.B.)
| | - Xavier Barreau
- Interventional Neuroradiology Department, Centre Hospitalier Régional Universitaire Bordeaux, France (G.M., X.B.)
| | - Frédéric Clarençon
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France (F.C., E.S.)
| | - Eimad Shotar
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France (F.C., E.S.)
| | - François Eugene
- Department of Neuroradiology, Centre Hospitalier Universitaire de Rennes, France (F.E.)
| | - Emmanuel Houdart
- Department of Neuroradiology, Lariboisière Hospital, Paris, France (E.H.)
| | - Benjamin Gory
- Department of Neuroradiology, Centre Hospitalier Universitaire de Rennes, France (B.G., F.Z.)
| | - François Zhu
- Department of Neuroradiology, Centre Hospitalier Universitaire de Rennes, France (B.G., F.Z.)
| | - Julien Labreuche
- Department of Biostatistics, Centre Hospitalier Universitaire Lille, Equipe d'accueil 2694 Santé Publique: Epidémiologie et Qualité des Soins, University Lille, France (J.L.)
| | - Michel Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (J.-P.D., M.P.)
| | - Bertrand Lapergue
- Diagnostic and Interventional Neuroradiology, Foch Hospital, Suresnes, France (A.S., B.L., A.C.)
| | - Arturo Consoli
- Diagnostic and Interventional Neuroradiology, Foch Hospital, Suresnes, France (A.S., B.L., A.C.)
| |
Collapse
|
2
|
Bourcier R, Consoli A, Desilles JP, Labreuche J, Kyheng M, Desal H, Alias Q, Gory B, Dargazanli C, Janot K, Zhu F, Lapergue B, Marnat G. Temporal trends in results of endovascular treatment of anterior intracranial large cerebral vessel occlusion: A 7-year study. Eur Stroke J 2023; 8:655-666. [PMID: 37288701 PMCID: PMC10472952 DOI: 10.1177/23969873231180338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/21/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Technical improvements in devices, changes in angiographic grading scales and various confounding factors have made difficult the detection of the temporal evolution of angiographic and clinical results after endovascular treatment (EVT) for acute ischemic Stroke (AIS). We analyzed this evolution in time using the Endovascular Treatment in Ischemic Stroke (ETIS) registry. MATERIALS AND METHODS We analyzed the efficacy outcomes of EVT performed from January 2015 to January 2022, and modelized the temporal trends using mixed logistic regression models, further adjusted for age, intravenous thrombolysis prior to EVT, general anesthesia, occlusion site, balloon catheter use and the type of first-line EVT strategy. We assessed heterogeneity in temporal trends according to occlusion site, balloon catheter use, cardio embolic etiology, age (<80 years vs ⩾80 years) and first-line EVT strategy. RESULTS Among 6104 patients treated from 2015 to 2021, the rates of successful reperfusion (71.1%-89.6%) and of complete first pass effect (FPE) (4.6%-28.9%) increase, whereas the rates of patients with >3 EVT device passes (43.1%-17.5%) and favorable outcome (35.8%-28.9%) decrease significantly over time. A significant heterogeneity in temporal trends in successful reperfusion according to the first-line EVT strategy was found (p-het = 0.018). The temporal trend of increasing successful reperfusion rate was only significant in patients treated with contact aspiration in first-line (adjusted overall effect p = 0.010). CONCLUSION In this 7-year-old large registry of ischemic stroke cases treated with EVT, we observed a significant increase with time in the rate of recanalization whereas there was a tendency toward a decrease in the rate of favorable outcome over the same period.
Collapse
Affiliation(s)
- Romain Bourcier
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Arturo Consoli
- Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch Suresnes FR, University of Versailles Saint Quentin-en-Yvelines, Saint Quentin-en-Yvelines, France
| | - Jean-Philippe Desilles
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, INSERM unit 1148, Paris-Cité University, Paris, France
| | - Julien Labreuche
- EA 2694 - Santé publique: épidémiologie et qualité des soins, University of Lille, CHU Lille, Lille, France
| | - Maeva Kyheng
- EA 2694 - Santé publique: épidémiologie et qualité des soins, University of Lille, CHU Lille, Lille, France
| | - Hubert Desal
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Quentin Alias
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Rennes, Rennes, France
| | - Benjamin Gory
- IADI, University of Lorraine, INSERM U1254, Nancy, France
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France
| | - Cyril Dargazanli
- Department of Neuroradiology, Guy de Chauliac University Hospital, Montpellier, France
| | - Kévin Janot
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Tours, Tours, France
| | - François Zhu
- IADI, University of Lorraine, INSERM U1254, Nancy, France
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France
| | - Bertrand Lapergue
- Department of Neurology, Hôpital Foch Suresnes FR, University of Versailles Saint Quentin-en-Yvelines, France
| | - Gaultier Marnat
- Department of Diagnostic and Interventional Neuroradiology, University Hospital, Bordeaux, France
| |
Collapse
|