Dong Yang1, Zhonghua Shi2, Min Lin3, Zhiming Zhou4, Wenjie Zi1, Huaiming Wang1,5, Yonggang Hao1,6, Fuqiang Guo7, Wenhua Liu8, Gelin Xu1, Yunyun Xiong1, Xinfeng Liu1. 1. 1 Department of Neurology, Jinling Hospital, Nanjing, China. 2. 2 Department of Neurosurgery, The 101st Hospital of The People's Liberation Army, Wuxi, China. 3. 3 Department of Neurology, Fuzhou General Hospital of Nanjing Military Region, Fuzhou, China. 4. 4 Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, China. 5. 5 Department of Neurology, The 89th Hospital of The People's Liberation Army, Weifang, China. 6. 6 Department of Neurology, Sir Run Run Shaw Hospital, Medical School of Zhejiang University, Hangzhou, China. 7. 7 Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, China. 8. 8 Department of Neurology, Wuhan No. 1 Hospital, Wuhan, China.
Abstract
OBJECTIVE: The endovascular treatment strategy for acute tandem occlusion stroke is challenging, and controversy exists regarding which lesion should be treated first. This study addresses the uncertainty regarding the priority choice for thrombectomy in acute anterior circulation tandem occlusion stroke. METHODS: We analysed the clinical and angiographic data of tandem stroke patients who underwent interventional therapy from the endovAsCular Treatment of acUte Anterior circuLation ischaemic stroke (ACTUAL) registry. Recanalisation was assessed according to the modified thrombolysis in cerebral infarction score. Clinical outcome was evaluated at 90 days using the modified Rankin scale score. RESULTS: Sixty tandem occlusion stroke patients were enrolled. Thirty-one (51.7%) patients received anterograde therapy, while 29 (48.3%) patients underwent the retrograde approach. Successful recanalisation (modified thrombolysis in cerebral infarction score 2b-3) occurred in 78.3% (47/60) of patients, and 50.0% (30/60) of patients achieved a modified Rankin scale score of 0-2 at 90 days. Patients undergoing the retrograde approach spent less time in distal occlusion recanalisation (125 (86-167) vs. 95 (74-122) minutes; P = 0.04) and achieved better functional outcomes at 90 days (69.0% (20/29) vs. 32.3% (10/31); P = 0.004) than patients who received anterograde therapy. The retrograde approach was associated with favourable clinical outcomes (odds ratio 0.21; 95% confidence interval 0.07-0.64; P = 0.006). CONCLUSION: For acute tandem occlusion stroke, favourable outcomes were better in patients undergoing retrograde therapy than in patients who received the anterograde approach. Future randomised trials are warranted to determine the optimal treatment.
OBJECTIVE: The endovascular treatment strategy for acute tandem occlusion stroke is challenging, and controversy exists regarding which lesion should be treated first. This study addresses the uncertainty regarding the priority choice for thrombectomy in acute anterior circulation tandem occlusion stroke. METHODS: We analysed the clinical and angiographic data of tandem strokepatients who underwent interventional therapy from the endovAsCular Treatment of acUte Anterior circuLation ischaemic stroke (ACTUAL) registry. Recanalisation was assessed according to the modified thrombolysis in cerebral infarction score. Clinical outcome was evaluated at 90 days using the modified Rankin scale score. RESULTS: Sixty tandem occlusion strokepatients were enrolled. Thirty-one (51.7%) patients received anterograde therapy, while 29 (48.3%) patients underwent the retrograde approach. Successful recanalisation (modified thrombolysis in cerebral infarction score 2b-3) occurred in 78.3% (47/60) of patients, and 50.0% (30/60) of patients achieved a modified Rankin scale score of 0-2 at 90 days. Patients undergoing the retrograde approach spent less time in distal occlusion recanalisation (125 (86-167) vs. 95 (74-122) minutes; P = 0.04) and achieved better functional outcomes at 90 days (69.0% (20/29) vs. 32.3% (10/31); P = 0.004) than patients who received anterograde therapy. The retrograde approach was associated with favourable clinical outcomes (odds ratio 0.21; 95% confidence interval 0.07-0.64; P = 0.006). CONCLUSION: For acute tandem occlusion stroke, favourable outcomes were better in patients undergoing retrograde therapy than in patients who received the anterograde approach. Future randomised trials are warranted to determine the optimal treatment.
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