Endovascular treatment for acute ischemic stroke in patients
with tandem lesion in the anterior circulation: analysis from
the METRICS study

J 2023

Endovascular treatment for acute ischemic stroke in patients with tandem lesion in the anterior circulation: analysis from the METRICS study

SANAK, Daniel, Martin KOCHER, Jana ZAPLETALOVA, Filip CIHLAR, Daniel CZERNY et. al.

Basic information

Original name

Endovascular treatment for acute ischemic stroke in patients with tandem lesion in the anterior circulation: analysis from the METRICS study

Authors

SANAK, Daniel (203 Czech Republic), Martin KOCHER (203 Czech Republic, guarantor), Jana ZAPLETALOVA (203 Czech Republic), Filip CIHLAR (203 Czech Republic), Daniel CZERNY (203 Czech Republic), David CERNIK (203 Czech Republic), Petr DURAS (203 Czech Republic), Jan FIKSA (203 Czech Republic), Jakub HUSTÝ (203 Czech Republic), Lubomir JURAK (203 Czech Republic), Martin KOVAR (203 Czech Republic), Jiri LACMAN (203 Czech Republic), Radek PADR (203 Czech Republic), Pavel PROCHAZKA (203 Czech Republic), Jan RAUPACH (203 Czech Republic), Martin REISER (203 Czech Republic), Vladimir ROHAN (203 Czech Republic), Martin ROUBEC (203 Czech Republic), Jindrich SOVA (203 Czech Republic), Miroslav SERCL (203 Czech Republic), Miroslav ŠKORŇA (203 Czech Republic, belonging to the institution), Libor SIMUNEK (203 Czech Republic), Alena SNAJDROVA (203 Czech Republic), Martin SRAMEK (203 Czech Republic) and Ales TOMEK (203 Czech Republic)

Edition

Journal of NeuroInterventional Surgery, London, BMJ PUBLISHING GROUP, 2023, 1759-8478

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30210 Clinical neurology

Country of publisher

United Kingdom of Great Britain and Northern Ireland

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 4.800 in 2022

RIV identification code

RIV/00216224:14110/23:00130230

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1136/jnis-2022-019176

UT WoS

000844719700001

Keywords in English

Stroke; Thrombectomy; Stent

Abstract

V originále

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.

Citovat

SANAK, Daniel, Martin KOCHER, Jana ZAPLETALOVA, Filip CIHLAR, Daniel CZERNY, David CERNIK, Petr DURAS, Jan FIKSA, Jakub HUSTÝ, Lubomir JURAK, Martin KOVAR, Jiri LACMAN, Radek PADR, Pavel PROCHAZKA, Jan RAUPACH, Martin REISER, Vladimir ROHAN, Martin ROUBEC, Jindrich SOVA, Miroslav SERCL, Miroslav ŠKORŇA, Libor SIMUNEK, Alena SNAJDROVA, Martin SRAMEK and Ales TOMEK. Endovascular treatment for acute ischemic stroke in patients with tandem lesion in the anterior circulation: analysis from the METRICS study. Journal of NeuroInterventional Surgery. London: BMJ PUBLISHING GROUP, 2023, vol. 15, e1, p. "e123"-"e128", 6 pp. ISSN 1759-8478. Available from: https://dx.doi.org/10.1136/jnis-2022-019176.

@article{2249640,
   author = {Sanak, Daniel and Kocher, Martin and Zapletalova, Jana and Cihlar, Filip and Czerny, Daniel and Cernik, David and Duras, Petr and Fiksa, Jan and Hustý, Jakub and Jurak, Lubomir and Kovar, Martin and Lacman, Jiri and Padr, Radek and Prochazka, Pavel and Raupach, Jan and Reiser, Martin and Rohan, Vladimir and Roubec, Martin and Sova, Jindrich and Sercl, Miroslav and Škorňa, Miroslav and Simunek, Libor and Snajdrova, Alena and Sramek, Martin and Tomek, Ales},
   article_location = {London},
   article_number = {e1},
   doi = {http://dx.doi.org/10.1136/jnis-2022-019176},
   keywords = {Stroke; Thrombectomy; Stent},
   language = {eng},
   issn = {1759-8478},
   journal = {Journal of NeuroInterventional Surgery},
   title = {Endovascular treatment for acute ischemic stroke in patients with tandem lesion in the anterior circulation: analysis from the METRICS study},
   url = {https://jnis.bmj.com/content/early/2022/08/24/jnis-2022-019176},
   volume = {15},
   year = {2023}
}

TY  - JOUR
ID  - 2249640
AU  - Sanak, Daniel - Kocher, Martin - Zapletalova, Jana - Cihlar, Filip - Czerny, Daniel - Cernik, David - Duras, Petr - Fiksa, Jan - Hustý, Jakub - Jurak, Lubomir - Kovar, Martin - Lacman, Jiri - Padr, Radek - Prochazka, Pavel - Raupach, Jan - Reiser, Martin - Rohan, Vladimir - Roubec, Martin - Sova, Jindrich - Sercl, Miroslav - Škorňa, Miroslav - Simunek, Libor - Snajdrova, Alena - Sramek, Martin - Tomek, Ales
PY  - 2023
TI  - Endovascular treatment for acute ischemic stroke in patients with tandem lesion in the anterior circulation: analysis from the METRICS study
JF  - Journal of NeuroInterventional Surgery
VL  - 15
IS  - e1
SP  - "e123"-"e128"
EP  - "e123"-"e128"
PB  - BMJ PUBLISHING GROUP
SN  - 17598478
KW  - Stroke
KW  - Thrombectomy
KW  - Stent
UR  - https://jnis.bmj.com/content/early/2022/08/24/jnis-2022-019176
N2  - 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.
ER  -

SANAK, Daniel, Martin KOCHER, Jana ZAPLETALOVA, Filip CIHLAR, Daniel CZERNY, David CERNIK, Petr DURAS, Jan FIKSA, Jakub HUSTÝ, Lubomir JURAK, Martin KOVAR, Jiri LACMAN, Radek PADR, Pavel PROCHAZKA, Jan RAUPACH, Martin REISER, Vladimir ROHAN, Martin ROUBEC, Jindrich SOVA, Miroslav SERCL, Miroslav ŠKORŇA, Libor SIMUNEK, Alena SNAJDROVA, Martin SRAMEK and Ales TOMEK. Endovascular treatment for acute ischemic stroke in patients with tandem lesion in the anterior circulation: analysis from the METRICS study. \textit{Journal of NeuroInterventional Surgery}. London: BMJ PUBLISHING GROUP, 2023, vol.~15, e1, p.~''e123''-''e128'', 6 pp. ISSN~1759-8478. Available from: https://dx.doi.org/10.1136/jnis-2022-019176.

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