Endovascular Treatment of Tandem Extracranial/Intracranial Anterior Circulation Occlusions
- 1 June 2011
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 42 (6), 1653-1657
- https://doi.org/10.1161/strokeaha.110.595520
Abstract
Background and Purpose— Acute ischemic stroke due to tandem occlusions of the extracranial internal carotid artery and intracranial arteries has a poor natural history. We aimed to evaluate our single-center experience with endovascular treatment of this unique stroke population. Methods— Consecutive patients with tandem occlusions of the internal carotid artery origin and an intracranial artery (ie, internal carotid artery terminus, M1 middle cerebral artery, or M2 middle cerebral artery) were studied retrospectively. Treatment consisted of proximal revascularization with angioplasty and stenting followed by intracranial intervention. Endpoints were recanalization of both extracranial and intracranial vessels (Thrombolysis In Myocardial Ischemia ≥2), parenchymal hematoma, and good clinical outcome (modified Rankin Scale ≤2) at 3 months. Results— We identified 77 patients with tandem occlusions. Recanalization occurred in 58 cases (75.3%) and parenchymal hematoma occurred in 8 cases (10.4%). Distal embolization occurred in 3 cases (3.9%). In 18 of 77 patients (23.4%), distal (ie, intracranial) recanalization was observed after proximal recanalization, obviating the need for distal intervention. Good clinical outcomes were achieved in 32 patients (41.6%). In multivariate analysis, Thrombolysis In Myocardial Ischemia ≥2 recanalization, baseline National Institutes of Health Stroke Scale score, baseline Alberta Stroke Programme Early CT score, and age were significantly associated with good outcome. Conclusions— Endovascular therapy of tandem occlusions using extracranial internal carotid artery revascularization as the first step is technically feasible, has a high recanalization rate, and results in an acceptable rate of good clinical outcome. Future randomized, prospective studies should clarify the role of this approach.Keywords
This publication has 12 references indexed in Scilit:
- Endovascular Thrombectomy for Acute Ischemic Stroke in Failed Intravenous Tissue Plasminogen Activator Versus Non–Intravenous Tissue Plasminogen Activator PatientsStroke, 2010
- Mechanical Approaches Combined With Intra-Arterial Pharmacological Therapy Are Associated With Higher Recanalization Rates Than Either Intervention Alone in Revascularization of Acute Carotid Terminus OcclusionStroke, 2009
- Recanalization and Reperfusion Therapies for Acute Ischemic StrokeCerebrovascular Diseases, 2009
- Intra-Arterial Thrombolytic Therapy for Hyperacute Ischemic Stroke Caused by Tandem OcclusionCerebrovascular Diseases, 2008
- Intra-Arterial Thrombolysis of Occluded Middle Cerebral Artery by Use of Collateral Pathways in Patients with Tandem Cervical Carotid Artery/Middle Cerebral Artery OcclusionAmerican Journal of Neuroradiology, 2008
- Impact of Arterial Reocclusion and Distal Fragmentation during Thrombolysis among Patients with Acute Ischemic StrokeAmerican Journal of Neuroradiology, 2008
- The Impact of Recanalization on Ischemic Stroke OutcomeStroke, 2007
- Tandem Internal Carotid Artery/Middle Cerebral Artery OcclusionStroke, 2006
- Emergent Stenting of Extracranial Internal Carotid Artery Occlusion in Acute Stroke Has a High Revascularization RateStroke, 2005
- Safety and Efficacy of Mechanical Embolectomy in Acute Ischemic StrokeStroke, 2005