Endovascular treatment of tandem vascular occlusions in acute ischemic stroke

Abstract

Our study shows preliminary data from three centers on recanalization of tandem occlusions in patients presenting with AIS. There was a preference to revascularize the proximal occlusion using a stent followed by distal recanalization with mechanical thrombectomy, intra-arterial thrombolysis or a combination of these. This approach has low periprocedural complications and can achieve an excellent angiographic and clinical outcome.

Carotid artery stenting in the context of endovascular treatment of acute ischemic stroke

“…This study showed a primary endpoint of recanalization without a sICH in 85% of patients (17/20). Our results were in accordance with results of previous similar studies (Table 3) 7, 8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25 . Furthermore, this study showed rates of recanalization, sICH, and mortality that were similar to those found in recent randomized trials on thrombectomy for acute stroke 2,3,4,5 .…”

“…Carotid tandem occlusions are defined as both extra-cranial occlusion or stenosis of the internal carotid artery (ICA) and downstream intracranial vessel occlusion, which comprises a subgroup of patients that usually present poor recanalization rates under IVT and poor clinical outcomes 6 . Despite of the lack of clinical data from randomized trials on the best management course of acute carotid tandem occlusions, a combined recanalization strategy by means of carotid artery stenting and mechanical thrombectomy has recently shown promising results 7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25 . We aimed to assess the clinical and radiological data of patients who underwent carotid artery stenting (CAS) and endovascular treatment of acute ischemic stroke due to carotid tandem occlusions.…”

Emergency Stenting of the Extracranial Internal Carotid Artery in Combination with Anterior Circulation Thrombectomy in Acute Ischemic Stroke: A Retrospective Multicenter Study

“…Most interesting, these series report relevant differences of the revascularization efficacy, with TICI Ն 2b results ranging from 63% to 79% of cases and the rate of favorable clinical outcome spanning a range of 29%-76%. [5][6][7][8][9][10]22 Moreover, the reported rates of sICH range from 0% to almost 22%, most probably due to low numbers of included patients in single-center designs (On-line Table). Regarding the clinical outcome, our results (36% favorable outcome) lay between the results of the above-mentioned studies (52% and 29% respectively).…”

Treatment Strategies for Acute Ischemic Stroke Caused by Carotid Artery Occlusion

“…Recently, several case series reported the efficacy and safety of emergency ICA stent placement followed by anterior circulation thrombectomy [10,11,12,30,31,32]. Despite the lack of direct comparative studies, the overall rate of successful reperfusion results [treatment in cerebral infarction (TICI) score ≥2b] ranged from 63 to 79% in these studies, which was similar to the rates reported in the recent stent-retriever trials in patients with isolated intracranial occlusions (modified TICI score ≥2b of 72.4% in ESCAPE, 88% in SWIFT PRIME).…”