Endovascular Treatment for Acute Tandem Occlusion Stroke: Results from Case Series of 17 Patients

Vu-Dang, Luu; Nguyen, Quan Huu; Nguyen-Thi-Thu, Trang; Tran, Anh‐Tuan; Le-Chi, Cong; Le-Hoang, Kien; Nguyen-Tat, Thien; Nguyen-Huu, An; Pham-Minh, Thong; Chu-Dinh, Thien; Chu, Dinh‐Toi

doi:10.4103/aian.aian_464_18

Cited by 7 publications

(6 citation statements)

References 18 publications

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“…The favorable clinical outcomes observed in this study were higher than in the DAWN (49%) and DEFUSE3 (45%) studies or the CLEAR study (42.1%) [3][4][5]. Compared with domestic research, this rate is lower than the study by author Vu Dang Luu (72.4%), higher than the study by author Tran Anh Tuan (47%), and equivalent to the rate by author Tran Thi Minh Hang (51.2%) [7], [13], [14]. Between the two mRS recovery outcomes after 3 months, there was no difference in core, penumbra, or mismatch ratio.…”

Section: Scientific Researchmentioning

confidence: 54%

Recovery Prognosis of Aspects in Patients With Acute Anterior Circulation Cerebral Infarction Undergoing Mechanical Thrombectomy

Nguyen,

Vu,

Tran

et al. 2023

vjrnm

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Aim: Comparison of the prognostic value of recovery of the ASPECTS score compared with perfusion imaging in patients with acute anterior circulation cerebral infarction undergoing thrombectomy. Materials and methods: Retrospective cross-sectional descriptive study combined with a prospective study of 82 cases undergoing CT scan without injection, CTA, and CTP, using RAPID software to calculate core and penumbra values and mechanical thrombectomy within 6-24 hours. Good (0-2 points) and poor (3-6 points) stroke outcomes were assessed at 3 months by the modified Rankin functional recovery score (mRS). Use the ROC curve and AUC value to compare the good and bad stroke prognostic value of ASPECTS and the core, penumbra, mismatch ratio values. Results: From January 2022 to May 2023, 82 patients were included in the study. At 90 days, the independent outcome rate of good mRS function (0-2) was 57.3%, and poor mRS function (3-6) was 42.7%. The ROC curve showed that, among the ASPECTS, core, penumbra, and mismatch ratio indices, only ASPECTS could predict stroke outcome well (p = 0.001<0.05), the area under the curve was 0.709 with J - point cutoff index at threshold ASPECTS = 6 with sensitivity 93.6% and specificity 57.1%. Conclusion: ASPECTS ≥ 6 can predict good functional recovery after stroke in patients with acute anterior circulation cerebral infarction undergoing thrombectomy at the extended window.

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Section: Scientific Researchmentioning

confidence: 54%

Recovery Prognosis of Aspects in Patients With Acute Anterior Circulation Cerebral Infarction Undergoing Mechanical Thrombectomy

Nguyen,

Vu,

Tran

et al. 2023

vjrnm

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“…According to the sequence of extracranial or intracranial lesions addressed, the treatment strategies are classified as the anterograde approach and retrograde approach. Tailored evidence for the optimal treatment order between antegrade and retrograde approaches remains inconsistent among studies, as both the approaches have innate advantages and disadvantages; in fact, some studies have shown comparable results between the two approaches [69] , [70] , [75] , [77] , while, in other studies a better outcome of the anterograde [74] or retrograde [68] , [71] , [72] , [73] , [76] approach have been shown. In patients from the TITAN cohort, the order of treatment of intracranial occlusion or cervical occlusion led to a similar rate of successful reperfusion [61] , with faster time from puncture to reperfusion in the retrograde approach group but with similar clinical outcomes.…”

Section: Treatment Strategies and Review Of Literaturementioning

confidence: 99%

“…Acute stent placement is usually associated to antithrombotic medication, to avoid stent thrombosis, which occurs in around 2% of patients and negatively impacts neurological outcomes [92] . The need to prevent intra-stent thrombosis collides with the need to prevent the symptomatic hemorrhagic transformation of the infarcted brain tissue, which occurs in about 10% of patients with TOs and significantly worsens the functional outcome [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , [86] , [87] , [88] , [89] , [90] , [91] , [92] . Antithrombotic treatment during stent acute placement should increase the risk of sICH, due to the coagulopathy caused by thrombolysis and to the disruption of the blood-brain barrier [93] (TAB.3).…”

Section: Treatment Strategies and Review Of Literaturementioning

confidence: 99%

“…DAPT is the most used antithrombotic treatment in many studies, albeit in different ways, with a marginal benefit on good functional outcome and carotid stent patency without a significant increase in risk of sICH [98] . Some studies have reported use of an IV loading dose of aspirin (250–500 mg) with a loading dose of clopidogrel (300 mg), which can be given immediately, without prior IVT [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] or 24 h later, after a postprocedural follow-up CT scan excludes hemorrhage [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , …”

Section: Treatment Strategies and Review Of Literaturementioning

confidence: 99%

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Diagnosis and management of tandem occlusion in acute ischemic stroke

Donna¹,

Muto²,

Giordano³

et al. 2023

European Journal of Radiology Open

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“…A total of 1,907 articles were initially identified through main electronic database and references of related studies, of which 34 full-text articles were retrieved for assessment after duplicates were removed and title/abstract screened. Eventually, 11 studies that met our inclusion criteria were eligible for final analysis (12)(13)(14)(15)(22)(23)(24)(25)(26)(27)(28). All the included studies had more than one outcome indicator available that was presented separately for comparison analysis between the different treatment strategies.…”

Section: Selection and Characteristics Of Studiesmentioning

confidence: 99%

Antegrade or Retrograde Approach for the Management of Tandem Occlusions in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Min

Bai

et al. 2022

Front. Neurol.

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Background: Acute ischemic stroke (AIS) caused by tandem intracranial and extracranial occlusions is not rare. However, optimal strategy between antegrade (extracranial first) or retrograde (intracranial first) approaches still remains elusive. This systematic review and meta-analysis aim to compare the two approaches to provide updated clinical evidence of strategy selection.Methods: PubMed, Ovid, Web of Science, and the Cochrane Library were searched for literature comparing antegrade and retrograde approaches for patients with AIS with concomitant tandem occlusions. Outcomes including successful reperfusion [Throbolysis in Cerebral Infarction (TICI) 2b−3] and 90-day favorable outcome [modified Rankin Scale (mRS) 0–2], any intracerebral hemorrhage, symptomatic intracerebral hemorrhage, procedural complications, and mortality were evaluated. The risk of bias was assessed using the Newcastle–Ottawa Scale and illustrated in the Funnel plot. Heterogeneity was assessed by I2 statistic. Subgroup and sensitivity analyses were also performed.Results: A total of 11 studies accounting 1,517 patients were included. 831 (55%) patients were treated with an antegrade approach and 686 (45%) patients were treated with the retrograde approach. A higher successful reperfusion rate was achieved in retrograde group than that of antegrade group [83.8 vs. 78.0%; odds ratio (OR): 0.63, 95% CI: 0.40–0.99, p = 0.04]. 90-day favorable outcome (mRS 0–2 at 90 days) also showed significantly higher in retrograde group compared with antegrade group (47.3 vs. 40.2%; OR: 0.72, 95% CI: 0.58–0.89, p = 0.002). The incidence of any intracranial hemorrhage (ICH), symptomatic intracranial hemorrhage, 90-day mortality, and other complications did not differ between two groups.Conclusion: In AIS with tandem occlusions, the retrograde approach might achieve a higher successful reperfusion rate and better functional outcome with a comparable safety profile when compared with an antegrade approach. Further prospective controlled studies with more meticulous design and a higher level of evidence are needed to confirm these results.Systematic Review Registration: “PROSPERO” database (CRD 42020199093), https://www.crd.york.ac.uk/PROSPERO/.

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Endovascular Treatment for Acute Tandem Occlusion Stroke: Results from Case Series of 17 Patients

Cited by 7 publications

References 18 publications

Recovery Prognosis of Aspects in Patients With Acute Anterior Circulation Cerebral Infarction Undergoing Mechanical Thrombectomy

Recovery Prognosis of Aspects in Patients With Acute Anterior Circulation Cerebral Infarction Undergoing Mechanical Thrombectomy

Diagnosis and management of tandem occlusion in acute ischemic stroke

Antegrade or Retrograde Approach for the Management of Tandem Occlusions in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

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