BACKGROUND: Ischemic strokes with tandem occlusions are associated with a poor prognosis. Recent studies demonstrating the effectiveness of endovascular treatment for large vessel occlusions have shown less impressive results in patients with tandem occlusions than in those with isolated intracranial occlusions. Also, the indications and effects of carotid stenting remain unclear. METHODS: From a prospectively gathered registry, we analyzed data of 70 consecutive patients who underwent mechanical endovascular treatment for acute stroke with tandem occlusions from November 2011 to August 2014. Clinical (including demographics, National Institutes of Health Stroke Scale (NIHSS), and stroke etiology), imaging (including diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score), and endovascular treatment data were assessed and reviewed in consensus by 2 observers. Good clinical outcome was defined as a modified Rankin Scale of ≤2 at 3-month follow-up. RESULTS: At 3-month follow-up, 50.8% had a poor clinical outcome, including death in 13.4%. Lower NIHSS (initial, at day 1, and at discharge) and successful recanalization (thrombolysis in cerebral infarction 2b-3) were associated with a good clinical outcome (p < 0.05). There were no statistically significant differences between patients with a good or poor clinical outcome in terms of intravenous (IV) tissue plasminogen activator use, delay between symptom onset and recanalization, and endovascular technique including the carotid stenting. CONCLUSIONS: Despite the recent randomized control trials demonstrating the effectiveness of thrombectomy, there is still a research gap about tandem occlusions. This subtype of stroke, which usually responds poorly to IV thrombolysis, is also difficult to treat by endovascular means. Guidelines for the endovascular management of tandem occlusions are needed.
BACKGROUND: Ischemic strokes with tandem occlusions are associated with a poor prognosis. Recent studies demonstrating the effectiveness of endovascular treatment for large vessel occlusions have shown less impressive results in patients with tandem occlusions than in those with isolated intracranial occlusions. Also, the indications and effects of carotid stenting remain unclear. METHODS: From a prospectively gathered registry, we analyzed data of 70 consecutive patients who underwent mechanical endovascular treatment for acute stroke with tandem occlusions from November 2011 to August 2014. Clinical (including demographics, National Institutes of Health Stroke Scale (NIHSS), and stroke etiology), imaging (including diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score), and endovascular treatment data were assessed and reviewed in consensus by 2 observers. Good clinical outcome was defined as a modified Rankin Scale of ≤2 at 3-month follow-up. RESULTS: At 3-month follow-up, 50.8% had a poor clinical outcome, including death in 13.4%. Lower NIHSS (initial, at day 1, and at discharge) and successful recanalization (thrombolysis in cerebral infarction 2b-3) were associated with a good clinical outcome (p < 0.05). There were no statistically significant differences between patients with a good or poor clinical outcome in terms of intravenous (IV) tissue plasminogen activator use, delay between symptom onset and recanalization, and endovascular technique including the carotid stenting. CONCLUSIONS: Despite the recent randomized control trials demonstrating the effectiveness of thrombectomy, there is still a research gap about tandem occlusions. This subtype of stroke, which usually responds poorly to IV thrombolysis, is also difficult to treat by endovascular means. Guidelines for the endovascular management of tandem occlusions are needed.
Authors: Alexandra R Paul; Pouya Entezami; Emad Nourollahzadeh; John Dalfino; Alan S Boulos Journal: Interv Neuroradiol Date: 2019-11-07 Impact factor: 1.610
Authors: O F Eker; P Panni; C Dargazanli; G Marnat; C Arquizan; P Machi; I Mourand; G Gascou; E Le Bars; V Costalat; A Bonafé Journal: AJNR Am J Neuroradiol Date: 2017-10-19 Impact factor: 3.825
Authors: Christopher Traenka; Simon Jung; Jan Gralla; Rebekka Kurmann; Christoph Stippich; Barbara Goeggel Simonetti; Henrik Gensicke; Hubertus Mueller; Karl Lovblad; Ashraf Eskandari; Francesco Puccinelli; Jochen Vehoff; Johannes Weber; Susanne Wegener; Levke Steiner; Georg Kägi; Andreas Luft; Roman Sztajzel; Urs Fischer; Leo H Bonati; Nils Peters; Patrik Michel; Philippe A Lyrer; Marcel Arnold; Stefan T Engelter Journal: Eur Stroke J Date: 2018-01-03
Authors: R Pop; A Hasiu; P H Mangin; F Severac; D Mihoc; D Nistoran; M Manisor; M Simu; S Chibbaro; R Gheoca; V Quenardelle; O Rouyer; V Wolff; R Beaujeux Journal: AJNR Am J Neuroradiol Date: 2021-02-18 Impact factor: 3.825
Authors: Guillaume Charbonnier; Louise Bonnet; Benjamin Bouamra; Fabrice Vuillier; Giovanni Vitale; Thierry Moulin; Elisabeth Medeiros De Bustos; Alessandra Biondi Journal: Cerebrovasc Dis Extra Date: 2020-04-28