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

BMC Neurology

Research Article

Anne Hege Aamodt¹  Christian G. Lund¹  Brian Anthony B. Enriquez¹  Mona Skjelland²  Bjørn Tennøe³  Terje Nome³  Cecilie G. Nome⁴  Mona K. Beyer⁵ 

[1] Department of Neurology, Oslo University Hospital, Oslo, Norway;Department of Neurology, Oslo University Hospital, Oslo, Norway;Institute of Clinical Medicine, University of Oslo, Oslo, Norway;Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway;Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway;Division of Anatomy, Department of Molecular Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway;Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway;Institute of Clinical Medicine, University of Oslo, Oslo, Norway;

关键词: Tandem occlusions;    Endovascular therapy;    Thrombectomy;    Stenting;    Diabetes;    Symptomatic intracranial hemorrhage;   

DOI  :  10.1186/s12883-023-03127-4

 received in 2022-06-09, accepted in 2023-02-15,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe 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.MethodsThis 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.ResultsOf 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.ConclusionsThe 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.

【 授权许可】

CC BY   
© The Author(s) 2023