Nevrologisk avdelingOslo universitetssykehus Forfa erbidrag: idé, utforming/design, li eratursøk, utarbeiding/revisjon av manuset samt godkjenning av innsendte manusversjon. Brian Anthony Enriquez er spesialist i nevrologi og overlege. Forfa eren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. Nevroradiologisk enhetOslo universitetssykehus, Rikshospitalet Forfa erbidrag: revisjon av manuset og godkjenning av innsendte manusversjon. Bjørn Tennøe er spesialist i radiologi og overlege i team for nevrovaskulaer intervensjon. Forfa eren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. Nevroradiologisk enhetOslo universitetssykehus, Rikshospitalet Forfa erbidrag: revisjon av manuset og godkjenning av innsendte manusversjon. Terje Nome er spesialist i radiologi og overlege i team for nevrovaskulaer intervensjon. Forfa eren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. Nevroradiologisk enhetOslo universitetssykehus, Rikshospitalet Forfa erbidrag: revisjon av manuset og godkjenning av innsendte manusversjon. Øyvind Gjertsen er spesialist i radiologi og overlege i team for nevrovaskulaer intervensjon. Forfa eren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. Nevroradiologisk enhetOslo universitetssykehus, Rikshospitalet Forfa erbidrag: godkjenning av innsendte manusversjon. Bård Nedregaard er spesialist i radiologi og overlege i team for nevrovaskulaer intervensjon. Forfa eren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter.Mekanisk trombektomi ved aku hjerneinfarkt | Tidsskrift for Den norske legeforening

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Background The endovascular treatment procedure in tandem occlusions (TO) is complex compared to single occlusion (SO) and optimal management remains uncertain. The aim of this study was to identify clinical and procedural factors that may be associated to efficacy and safety in the management of TO and compare functional outcome in TO and SO stroke patients. Methods This is a retrospective single center study of medium (MeVO) and large vessel occlusion (LVO) of the anterior circulation. Clinical, imaging, and interventional data were analyzed to identify predictive factors for symptomatic intracranial hemorrhage (sICH) and functional outcome after endovascular treatment (EVT) in TO. Functional outcome in TO and SO patients was compared. Results Of 662 anterior circulation stroke patients with MeVO and LVO stroke, 90 (14%) had TO. Stenting was performed in 73 (81%) of TO patients. Stent thromboses occurred in 8 (11%) patients. Successful reperfusion with modified thrombolysis in cerebral infarction (mTICI) ≥ 2b was achieved in 82 (91%). SICH occurred in seven (8%). The strongest predictors for sICH were diabetes mellitus and number of stent retriever passes. Good functional clinical outcome (mRS ≤ 2) at 90-day follow up was similar in TO and SO patients (58% vs 59% respectively). General anesthesia (GA) was associated with good functional outcome whereas hemorrhage in the infarcted tissue, lower mTICI score and history of smoking were associated with poor outcome. Conclusions The risk of sICH was increased in patients with diabetes mellitus and those with extra stent-retriever attempts. Functional clinical outcomes in patients with TO were comparable to patients with SO.

Background The endovascular treatment procedure in tandem occlusions (TO) is complex compared to single occlusion (SO) and optimal management remains uncertain. The aim of this study was to identify clinical and procedural factors that may be associated to efficacy and safety in the management of TO and compare functional outcome in TO and SO stroke patients. Methods This is a prospective, observational single center study of medium (MeVO) and large vessel occlusion (LVO) of the anterior circulation. Clinical, imaging, and interventional data were analyzed to identify predictive factors for symptomatic intracranial hemorrhage (sICH) and functional outcome after endovascular treatment (EVT). Functional outcome in TO and SO patients was compared. Results Of 662 anterior circulation stroke patients with MeVO and LVO stroke, 90 (14%) had TO. Stenting was performed in 73 (81%) of TO patients. Successful reperfusion with modified thrombolysis in cerebral infarction (mTICI) ≥ 2b was achieved in 82 (91%). SICH occurred in seven (8%). The strongest predictors for sICH were diabetes mellitus and number of stent retriever passes. Good functional clinical outcome (mRS ≤ 2) at 90-day follow up was similar in TO and SO patients (58% vs 59% respectively). General anesthesia (GA) was associated with good functional outcome whereas hemorrhage in the infarcted tissue, lower mTICI score and history of smoking were associated with poor outcome. Conclusions The risk of sICH was increased in patients with diabetes mellitus and those with extra stent-retriever attempts. Functional clinical outcomes in patients with TO were comparable to patients with SO.