Outcome and risk of hemorrhage in patients with tandem lesions after endovascular treatment: A propensity score-matched case-control study
Objectives: Endovascular treatment of acute stroke patients with large vessel occlusions is well established. But tandem lesions of the internal carotid artery and the intracranial anterior circulation remain a challenge regarding the technical conditions and the putative higher risk of hemorrhage d...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | Heliyon |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405844023017152 |
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| author | Dominik Sepp Maria Berndt Sebastian Mönch Benno Ikenberg Silke Wunderlich Christian Maegerlein Claus Zimmer Tobias Boeckh-Behrens Benjamin Friedrich |
| author_facet | Dominik Sepp Maria Berndt Sebastian Mönch Benno Ikenberg Silke Wunderlich Christian Maegerlein Claus Zimmer Tobias Boeckh-Behrens Benjamin Friedrich |
| author_sort | Dominik Sepp |
| collection | DOAJ |
| description | Objectives: Endovascular treatment of acute stroke patients with large vessel occlusions is well established. But tandem lesions of the internal carotid artery and the intracranial anterior circulation remain a challenge regarding the technical conditions and the putative higher risk of hemorrhage due to often required antiplatelet therapy.This study aims to evaluate the clinical outcome and the risk of hemorrhage after endovascular treatment of tandem lesions, with special regard to the periprocedural antiplatelet regimen. Materials and Methods: In this retrospective study, we included 63 consecutive stroke patients with endovascular treated tandem lesions. One hundred eleven patients with a solitary intracranial occlusion were matched using a “propensity score-matched analysis” with the covariates sex, age, wake-up stroke, iv-thrombolysis and NIHSS. Results: Rates of successful recanalization (mTICI 2b/3) and periprocedural complications were equal in both groups (P = 0.19; P = 0.35). The rate of good clinical outcome (mRS≤2) was similar, and the incidence of symptomatic hemorrhages was not significantly different (7.9% tandem lesions vs. 5.4% isolated intracranial occlusion, P = 0.51). Even intensified antiplatelet therapy in patients with tandem lesions did not increase the rate of symptomatic intracranial hemorrhages (P = 0.87). Conclusions: Clinical outcome and symptomatic intracranial hemorrhages did not differ significantly between endovascular treated patients with tandem lesions and matched patients with solitary intracranial occlusions, regardless of the antiplatelet regimen. Therefore, the complex technical requirements for recanalization of a tandem lesion and the putative higher risk should not result in reluctant treatment that would decrease the chance of a good clinical outcome. |
| first_indexed | 2024-04-09T19:22:15Z |
| format | Article |
| id | doaj.art-54a456ed996646a19a7821c9980fff26 |
| institution | Directory Open Access Journal |
| issn | 2405-8440 |
| language | English |
| last_indexed | 2024-04-09T19:22:15Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heliyon |
| spelling | doaj.art-54a456ed996646a19a7821c9980fff262023-04-05T08:26:01ZengElsevierHeliyon2405-84402023-03-0193e14508Outcome and risk of hemorrhage in patients with tandem lesions after endovascular treatment: A propensity score-matched case-control studyDominik Sepp0Maria Berndt1Sebastian Mönch2Benno Ikenberg3Silke Wunderlich4Christian Maegerlein5Claus Zimmer6Tobias Boeckh-Behrens7Benjamin Friedrich8Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; Corresponding author. Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany.Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, GermanyDepartment of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, GermanyDepartment of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, GermanyDepartment of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, GermanyDepartment of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, GermanyDepartment of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, GermanyDepartment of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, GermanyDepartment of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, GermanyObjectives: Endovascular treatment of acute stroke patients with large vessel occlusions is well established. But tandem lesions of the internal carotid artery and the intracranial anterior circulation remain a challenge regarding the technical conditions and the putative higher risk of hemorrhage due to often required antiplatelet therapy.This study aims to evaluate the clinical outcome and the risk of hemorrhage after endovascular treatment of tandem lesions, with special regard to the periprocedural antiplatelet regimen. Materials and Methods: In this retrospective study, we included 63 consecutive stroke patients with endovascular treated tandem lesions. One hundred eleven patients with a solitary intracranial occlusion were matched using a “propensity score-matched analysis” with the covariates sex, age, wake-up stroke, iv-thrombolysis and NIHSS. Results: Rates of successful recanalization (mTICI 2b/3) and periprocedural complications were equal in both groups (P = 0.19; P = 0.35). The rate of good clinical outcome (mRS≤2) was similar, and the incidence of symptomatic hemorrhages was not significantly different (7.9% tandem lesions vs. 5.4% isolated intracranial occlusion, P = 0.51). Even intensified antiplatelet therapy in patients with tandem lesions did not increase the rate of symptomatic intracranial hemorrhages (P = 0.87). Conclusions: Clinical outcome and symptomatic intracranial hemorrhages did not differ significantly between endovascular treated patients with tandem lesions and matched patients with solitary intracranial occlusions, regardless of the antiplatelet regimen. Therefore, the complex technical requirements for recanalization of a tandem lesion and the putative higher risk should not result in reluctant treatment that would decrease the chance of a good clinical outcome.http://www.sciencedirect.com/science/article/pii/S2405844023017152StentingStrokeTandem occlusionThrombectomyAntiplatelet agents |
| spellingShingle | Dominik Sepp Maria Berndt Sebastian Mönch Benno Ikenberg Silke Wunderlich Christian Maegerlein Claus Zimmer Tobias Boeckh-Behrens Benjamin Friedrich Outcome and risk of hemorrhage in patients with tandem lesions after endovascular treatment: A propensity score-matched case-control study Heliyon Stenting Stroke Tandem occlusion Thrombectomy Antiplatelet agents |
| title | Outcome and risk of hemorrhage in patients with tandem lesions after endovascular treatment: A propensity score-matched case-control study |
| title_full | Outcome and risk of hemorrhage in patients with tandem lesions after endovascular treatment: A propensity score-matched case-control study |
| title_fullStr | Outcome and risk of hemorrhage in patients with tandem lesions after endovascular treatment: A propensity score-matched case-control study |
| title_full_unstemmed | Outcome and risk of hemorrhage in patients with tandem lesions after endovascular treatment: A propensity score-matched case-control study |
| title_short | Outcome and risk of hemorrhage in patients with tandem lesions after endovascular treatment: A propensity score-matched case-control study |
| title_sort | outcome and risk of hemorrhage in patients with tandem lesions after endovascular treatment a propensity score matched case control study |
| topic | Stenting Stroke Tandem occlusion Thrombectomy Antiplatelet agents |
| url | http://www.sciencedirect.com/science/article/pii/S2405844023017152 |
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