Predictors of outcome after endovascular treatment for tandem occlusions: a single center retrospective analysis

Abstract

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.

Mediation Analysis of Acute Carotid Stenting in Tandem Lesions

“…Durable patency of the carotid artery may prevent recurrent intracranial embolisms, hemodynamic insufficiency (resulting in the expansion of the ischemic cerebral territory), carotid artery restenosis or reocclusion, and the shedding of unstable plaque. 4,38,39 In addition, considering that reperfusion is an important predictor of functional outcomes in TLs, 1,40 it has been suggested that the advantage of acute CAS is most likely related to the augmentation of intracranial perfusion. 41 In our analysis, we examined acute CAS as the exposure and used successful reperfusion as the mediating factor.…”