Tandem Lesions in Anterior Circulation Stroke
- 1 April 2021
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 52 (4), 1265-1275
- https://doi.org/10.1161/strokeaha.120.031797
Abstract
Background and Purpose: Tandem lesions in the anterior circulation account for up to 30% of all large vessel occlusion strokes. The optimal periprocedural approach in these lesions is still a matter of debate. Methods: Data from the German Stroke Registry—Endovascular Treatment between June 2015 and December 2019 were analyzed. The German Stroke Registry—Endovascular Treatment is an academic, independent, prospective, multicenter, observational registry study with 25 participating stroke centers from all over Germany enrolling consecutive mechanical thrombectomy patients. Tandem lesions were defined as a combination of a relevant extracranial internal carotid artery (ICA) pathology (ipsilateral stenosis >70% or occlusion) and concomitant intracranial large vessel occlusion. Successful reperfusion was defined as modified thrombolysis in cerebral infarction score of 2b-3. The modified Rankin Scale of 0 to 2 at 3 months indicated good outcome. The aim of this study was to investigate the safety and efficacy of different technical strategies in tandem lesions. Results: Out of 6635 patients, 874 (13.2%) presented with tandem lesions. Of these, 607 (69.5%) underwent acute treatment of the extracranial ICA. Acute treatment of the extracranial ICA lesion led to a higher probability of successful reperfusion (odds ratio, 40.63 [95% CI, 30.03–70.06]) compared with patients who did not undergo acute treatment of the extracranial ICA lesion and was associated with good clinical outcome (39.5% versus 29.3%, PPP=0.035) and intravenous thrombolysis (odds ratio, 10.58 [95% CI, 10.04–20.4]; P=0.033). Intracranial-first approach (n=227) compared with extracranial-first approach (n=267) resulted in a shorter time to flow restoration (53.5 versus 72.0 minutes, PP=0.24) without differences in periprocedural complications. Conclusions: In tandem lesions in the anterior circulation, acute treatment of the extracranial ICA lesion is associated with better clinical outcome and lower mortality. The intracranial-first approach might provide advantages. Download figure Download PowerPointKeywords
This publication has 25 references indexed in Scilit:
- Akuttherapie des ischämischen Schlaganfalls – Rekanalisierende TherapieAktuelle Neurologie, 2016
- Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trialsThe Lancet, 2016
- Thrombectomy assisted by carotid stenting in acute ischemic stroke management: benefits and harmsZeitschrift für Neurologie, 2015
- Emergency Stenting of the Extracranial Internal Carotid Artery in Combination with Anterior Circulation Thrombectomy in Acute Ischemic Stroke: A Retrospective Multicenter StudyAmerican Journal of Neuroradiology, 2015
- Mechanical thrombectomy in tandem occlusion: procedural considerations and clinical resultsNeuroradiology, 2014
- Carotid stenting and intracranial thrombectomy for treatment of acute stroke due to tandem occlusions with aggressive antiplatelet therapy may be associated with a high incidence of intracranial hemorrhageJournal of NeuroInterventional Surgery, 2014
- Two in One: Endovascular Treatment of Acute Tandem Occlusions in the Anterior CirculationClinical Neuroradiology, 2014
- Carotid Artery Stenting in Acute StrokeJournal of the American College of Cardiology, 2011
- Endovascular Treatment of Tandem Extracranial/Intracranial Anterior Circulation OcclusionsStroke, 2011
- Tandem Internal Carotid Artery/Middle Cerebral Artery OcclusionStroke, 2006