NCT03978988: TITAN

Thrombectomy In TANdem Occlusion

Active, enrolled NA Last updated 5 June 2025

What this trial tests

NA trial testing Carotid Stenting in Carotid Artery Diseases in 432 participants. Participants enrolled and being followed up; not accepting new ones.

Timeline

29 April 2020

Primary endpoint
8 March 2025

6 March 2026

Quick facts

Lead sponsor	Central Hospital, Nancy, France
Phase	NA
Status	Active, enrolled
Study type	INTERVENTIONAL
Allocation	randomized
Design	parallel
Masking	none
Primary purpose	other
Enrollment	432
Start date	29 April 2020
Primary completion	8 March 2025
Estimated completion	6 March 2026
Sites	1 location across France

Drugs / interventions tested

• Carotid Stenting
• Procedural Aspirin — full drug profile →
• Dual dual antiplatelet therapy after 24-hours imaging follow-up — full drug profile →
• Intracranial thrombectomy

Conditions studied

• Carotid Artery Diseases — all drugs for Carotid Artery Diseases →
• Thrombectomy — all drugs for Thrombectomy →
• Tandem Occlusion — all drugs for Tandem Occlusion →
• Stroke — all drugs for Stroke →

Sponsor

Central Hospital, Nancy, France

Who can join

18 and older, any sex, with Carotid Artery Diseases or Thrombectomy. Patients with the condition only — healthy volunteers not accepted.

Sponsor's own description

Tandem occlusion is defined by an acute ischemic stroke (AIS) with concomitant steno-occlusive disease of the extra cranial carotid artery and concerned about 10% of AIS patients. Whereas endovascular treatment has shown its efficiency in AIS by large vessel occlusion (LVO), to date, there is no consensus on the endovascular management of the extra cranial carotid artery in tandem occlusion. Only few of them were included in previous randomized trials who evaluated mechanical thrombectomy and were often listed in the non-inclusion criteria. Therapeutic management of this population was not specifically addressed in recent trials. Endovascular management can be complex with the need of acute stenting of the extra cranial carotid lesion along with the potential need of antithrombotic therapy initiation, the benefit and the safety of stenting of the cervical lesion in acute phase of AIS have shown encouraging results but however remains to be assessed. The TITAN (Thrombectomy In TANdem lesion) trial aims to demonstrate the superiority of the combined use of intracranial thrombectomy and extracranial carotid stenting compared to intracranial thrombectomy alone on the complete reperfusion rate in patients with acute ischemic stroke due to tandem lesion.

Publications & conference data

8 peer-reviewed publications reference this trial (live from Europe PMC):

1. Acute ischaemic stroke: recent advances in reperfusion treatment.
   Widimsky P, Snyder K, Sulzenko J, Hopkins LN, et al · · 2023 · cited 82× · PMID 36477996 · DOI 10.1093/eurheartj/ehac684
2. Tandem Carotid Lesions in Acute Ischemic Stroke: Mechanisms, Therapeutic Challenges, and Future Directions.
   Poppe AY, Jacquin G, Roy D, Stapf C, et al · · 2020 · cited 60× · PMID 32499251 · DOI 10.3174/ajnr.a6582
3. Effect of emergent carotid stenting during endovascular therapy for acute anterior circulation stroke patients with tandem occlusion: A multicenter, randomized, clinical trial (TITAN) protocol.
   Zhu F, Hossu G, Soudant M, Richard S, et al · · 2021 · cited 58× · PMID 32515696 · DOI 10.1177/1747493020929948
4. Considerations for Antiplatelet Management of Carotid Stenting in the Setting of Mechanical Thrombectomy: A Delphi Consensus Statement.
   Goyal M, Yoshimura S, Milot G, Fiehler J, et al · · 2020 · cited 28× · PMID 33122218 · DOI 10.3174/ajnr.a6888
5. Diagnosis and management of <i>tandem</i> occlusion in acute ischemic stroke.
   Di Donna A, Muto G, Giordano F, Muto M, et al · · 2023 · cited 23× · PMID 37609048 · DOI 10.1016/j.ejro.2023.100513
6. Safety Outcomes of Mechanical Thrombectomy Versus Combined Thrombectomy and Intravenous Thrombolysis in Tandem Lesions.
   Rodriguez-Calienes A, Galecio-Castillo M, Farooqui M, Hassan AE, et al · · 2023 · cited 18× · PMID 37602387 · DOI 10.1161/strokeaha.123.042966
7. Intravenous thrombolysis with tenecteplase versus alteplase combined with endovascular treatment of anterior circulation tandem occlusions: A pooled analysis of ETIS and TETRIS.
   Marnat G, Lapergue B, Gory B, Kyheng M, et al · · 2024 · cited 13× · PMID 37837202 · DOI 10.1177/23969873231206894
8. Safety and efficacy of tenecteplase versus alteplase in stroke patients with carotid tandem lesions: Results from the AcT trial.
   Bala F, Almekhlafi M, Singh N, Alhabli I, et al · · 2024 · cited 10× · PMID 37731173 · DOI 10.1177/17474930231205208