{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T06:40:11Z","timestamp":1789800011964,"version":"4.0.1"},"reference-count":24,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J NeuroIntervent Surg"],"accepted":{"date-parts":[[2021,4,14]]},"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Endovascular therapy (EVT) is effective and safe in patients with tandem occlusion. The benefit of intravenous thrombolysis (IVT) prior to EVT in acute tandem occlusion is debatable.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To compare EVT alone with EVT plus IVT in patients with acute ischemic stroke due to anterior circulation tandem occlusions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This is an individual patient pooled analysis of the Thrombectomy In TANdem lesions (TITAN) and Endovascular Treatment in Ischemic Stroke (ETIS) Registries. Patients were divided into two groups based on prior IVT treatment: (1) IVT+ group, which included patients who received IVT prior to EVT, (2) IVT\u2212 group, which included patients who did not receive IVT prior to EVT. Propensity score (inverse probability of treatment weighting (IPTW)) was used to reduce baseline between-group differences. The primary outcome was favorable outcome\u2014that is, modified Rankin Scale (mRS) score 0 to 2 at 90 days.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Overall, 602 consecutive patients with an acute stroke with tandem occlusion were included (380 and 222 in the bridging therapy and EVT alone groups, respectively). Onset to imaging time was shorter in the IVT+ group (median 103 vs 140 min). In contrast, imaging to puncture time was longer in the IVT+ group (median 107 vs 91 min). In IPTW analysis, the IVT+ group had higher odds of favorable outcome, excellent outcome (90-day mRS score 0\u20131), and successful reperfusion (modified Thrombolysis in Cerebral Infarction score 2b\/3 at the end of EVT). There was no difference in the risk of significant hemorrhagic complications between groups. In secondary analysis of patients treated with acute cervical internal carotid artery stenting, bridging therapy was associated with higher odds of favorable outcome and lower odds of mortality at 90 days.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Our results suggest that bridging therapy in patients with acute ischemic stroke due to anterior tandem occlusion is safe and may improve functional outcome, even in the setting of acute cervical internal carotid artery stenting during EVT.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/neurintsurg-2020-017202","type":"journal-article","created":{"date-parts":[[2021,4,28]],"date-time":"2021-04-28T14:38:17Z","timestamp":1619620697000},"page":"314-320","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":53,"title":["Endovascular therapy with or without intravenous thrombolysis in acute stroke with tandem occlusion"],"prefix":"10.1136","volume":"14","clinical-trial-number":[{"clinical-trial-number":"nct03776877","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7813-2949","authenticated-orcid":false,"given":"Mohammad","family":"Anadani","sequence":"first","affiliation":[{"name":"Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA"},{"name":"Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7611-7753","authenticated-orcid":false,"given":"Gaultier","family":"Marnat","sequence":"additional","affiliation":[{"name":"Department of Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6640-8541","authenticated-orcid":false,"given":"Arturo","family":"Consoli","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology, Hospital Foch, Suresnes, France"},{"name":"Interventional Neurovascular Unit, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiotis","family":"Papanagiotou","sequence":"additional","affiliation":[{"name":"Klinikum Bremen-Mitte gGmbH, Bremen, Germany"},{"name":"National and Kapodistrian University of Athens - Aretaiio Hospital, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raul G","family":"Nogueira","sequence":"additional","affiliation":[{"name":"Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro M","family":"Spiotta","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romain","family":"Bourcier","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Nantes University Hospital, Nantes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maeva","family":"Kyheng","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Lille, CHU Lille, EA 2694 - Sant\u00e9 publique : \u00e9pid\u00e9miologie et qualit\u00e9 des soins, Universit\u00e9 de Lille, Lille, Hauts-de-France, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Labreuche","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Lille, CHU Lille, EA 2694 - Sant\u00e9 publique : \u00e9pid\u00e9miologie et qualit\u00e9 des soins, Universit\u00e9 de Lille, Lille, Hauts-de-France, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adnan H","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9242-043X","authenticated-orcid":false,"given":"Marc","family":"Ribo","sequence":"additional","affiliation":[{"name":"Stroke Unit, Neurology, Hospital Vall d'Hebron, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8178-8597","authenticated-orcid":false,"given":"Adam","family":"de Havenon","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Utah, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Urs","family":"Fischer","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital, Bern University Hospital, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor","family":"Sibon","sequence":"additional","affiliation":[{"name":"Department of Neurology, Stroke Unit, Bordeaux University Hospital, Bordeaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyril","family":"Dargazanli","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, CHRU Gui de Chauliac, Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Arquizan","sequence":"additional","affiliation":[{"name":"Department of Neurology, CHRU Gui de Chauliac, Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe","family":"Cognard","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Therapeutic Neuroradiology, Toulouse University Hospital, Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean Marc","family":"Olivot","sequence":"additional","affiliation":[{"name":"Department of Neurology, Toulouse University Hospital, Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ren\u00e9","family":"Anxionnat","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Therapeutic Neuroradiology, Universit\u00e9 de Lorraine, CHRU-Nancy, Nancy, France"},{"name":"Universit\u00e9 de Lorraine, IADI, INSERM U1254, Nancy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00e9rard","family":"Audibert","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Surgical Intensive Care, Universit\u00e9 de Lorraine, CHRU-Nancy, Nancy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikael","family":"Mazighi","sequence":"additional","affiliation":[{"name":"Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raphael","family":"Blanc","sequence":"additional","affiliation":[{"name":"Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bertrand","family":"Lapergue","sequence":"additional","affiliation":[{"name":"Department of Neurology, Stroke Unit, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, 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