Impact of intravenous thrombolysis and emergent carotid stenting on reperfusion and clinical outcomes in patients with acute stroke with tandem lesion treated with thrombectomy: a collaborative pooled analysis

Abstract

Background and Purpose Tandem anterior circulation lesions in the setting of acute ischemic stroke (AIS) are a complex endovascular situation which has not been specifically addressed in trials. We determined the predictors of successful reperfusion and good clinical outcome at 90 days after mechanical thrombectomy (MT) in AIS patients with tandem lesions in a pooled collaborative study. Methods A retrospective analysis of consecutive patients presenting to 18 comprehensive stroke centers with AIS due to tandem lesion of the anterior circulation who underwent MT. Results A total of 395 patients were included. Successful reperfusion (modified Thrombolysis In Cerebral Infarction score 2b‐3) was achieved in 76.7%. At 90 days, 52.2% achieved a good outcome (modified Rankin Scale score 0‐2), 13.8% suffered a parenchymal hematoma and 13.2% were dead. Lower NIHSS score (OR 1.26, 95%CI 1.07‐1.48, P=0.004), Alberta Stroke Program Early CT Score (ASPECTS) score ≥7 (OR 2,00, 95%CI 1.07‐3.43, P=0.011), intravenous thrombolysis (OR 1.47 95%CI 1.01‐2.12, P=0.042), and stenting of the extracranial carotid lesion (OR 1.63, 95%CI 1.04‐2;53, P=0.030) were independently associated with successful reperfusion. Lower age (OR 1.58, 95%CI 1.26‐1.97, PP=0.018), lower NIHSS scores (OR 2.04 95%CI 1.53‐2.72, PP=0.013), proximal middle cerebral artery occlusion (OR 1.59, 95%CI 1.03‐2.44, P=0.035) independently predicted 90‐day good outcome. Conclusions Intravenous thrombolysis and emergent stenting of the extracranial carotid lesion were predictors of a successful reperfusion after MT of AIS patients with tandem lesion of the anterior circulation.