Diagnosis and management of tandem occlusion in acute ischemic stroke
Approximately 20–30% of patients with acute ischemic stroke, caused by large intracranial vessel occlusion, have a tandem lesion, defined as simultaneous presence of high-grade stenosis or occlusion of the cervical internal carotid artery and thromboembolic occlusion of the intracranial terminal int...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-12-01
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| Series: | European Journal of Radiology Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352047723000394 |
| _version_ | 1827591604998766592 |
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| author | Antonio Di Donna Gianluca Muto Flavio Giordano Massimo Muto Gianluigi Guarnieri Giovanna Servillo Antonio De Mase Emanuele Spina Giuseppe Leone |
| author_facet | Antonio Di Donna Gianluca Muto Flavio Giordano Massimo Muto Gianluigi Guarnieri Giovanna Servillo Antonio De Mase Emanuele Spina Giuseppe Leone |
| author_sort | Antonio Di Donna |
| collection | DOAJ |
| description | Approximately 20–30% of patients with acute ischemic stroke, caused by large intracranial vessel occlusion, have a tandem lesion, defined as simultaneous presence of high-grade stenosis or occlusion of the cervical internal carotid artery and thromboembolic occlusion of the intracranial terminal internal carotid artery or its branches, usually the middle cerebral artery. Patients with tandem lesions have usually worse outcomes than patients with single intracranial occlusions, and intravenous thrombolysis is less effective in these patients. Although endovascular thrombectomy is currently a cornerstone therapy in the management of acute ischemic stroke due to large vessel occlusion, the optimal management of extracranial carotid lesions in tandem occlusion remains controversial. Acute placement of a stent in the cervical carotid artery lesion is the most used therapeutic strategy compared with stented balloon angioplasty and thrombectomy alone without carotid artery revascularization; however, treatment strategies in these patients are often more complex than with single occlusion, so treatment decisions can change based on clinical and technical considerations. The aim of this review is to analyze the results of different studies and trials, investigating the periprocedural neurointerventional management of patients with tandem lesions and the safety, efficacy of the different technical strategies available as well as their impact on the clinical outcome in these patients, to strengthen current recommendations and thus optimize patient care. |
| first_indexed | 2024-03-09T01:34:07Z |
| format | Article |
| id | doaj.art-44a91262ec7c4e6a8417c6284879821d |
| institution | Directory Open Access Journal |
| issn | 2352-0477 |
| language | English |
| last_indexed | 2024-03-09T01:34:07Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | European Journal of Radiology Open |
| spelling | doaj.art-44a91262ec7c4e6a8417c6284879821d2023-12-09T06:06:39ZengElsevierEuropean Journal of Radiology Open2352-04772023-12-0111100513Diagnosis and management of tandem occlusion in acute ischemic strokeAntonio Di Donna0Gianluca Muto1Flavio Giordano2Massimo Muto3Gianluigi Guarnieri4Giovanna Servillo5Antonio De Mase6Emanuele Spina7Giuseppe Leone8Unit of Interventional Neuroradiology, Department of Advanced Diagnostic and Therapeutic Technologies, A.O.R.N. Antonio Cardarelli Hospital, Via Cardarelli 1, Naples 80131, ItalyDivision of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, 1205 Geneva, SwitzerlandUnit of Interventional Neuroradiology, Department of Advanced Diagnostic and Therapeutic Technologies, A.O.R.N. Antonio Cardarelli Hospital, Via Cardarelli 1, Naples 80131, ItalyUnit of Interventional Neuroradiology, Department of Advanced Diagnostic and Therapeutic Technologies, A.O.R.N. Antonio Cardarelli Hospital, Via Cardarelli 1, Naples 80131, ItalyUnit of Interventional Neuroradiology, Department of Advanced Diagnostic and Therapeutic Technologies, A.O.R.N. Antonio Cardarelli Hospital, Via Cardarelli 1, Naples 80131, ItalyUnit of Neurorology and Stroke Unit, Department of Emergency and Acceptance, A.O.R.N. Antonio Cardarelli Hospital, Via Cardarelli 1, Naples 80131, ItalyUnit of Neurorology and Stroke Unit, Department of Emergency and Acceptance, A.O.R.N. Antonio Cardarelli Hospital, Via Cardarelli 1, Naples 80131, ItalyUnit of Neurorology and Stroke Unit, Department of Emergency and Acceptance, A.O.R.N. Antonio Cardarelli Hospital, Via Cardarelli 1, Naples 80131, ItalyUnit of Interventional Neuroradiology, Department of Advanced Diagnostic and Therapeutic Technologies, A.O.R.N. Antonio Cardarelli Hospital, Via Cardarelli 1, Naples 80131, Italy; Corresponding author.Approximately 20–30% of patients with acute ischemic stroke, caused by large intracranial vessel occlusion, have a tandem lesion, defined as simultaneous presence of high-grade stenosis or occlusion of the cervical internal carotid artery and thromboembolic occlusion of the intracranial terminal internal carotid artery or its branches, usually the middle cerebral artery. Patients with tandem lesions have usually worse outcomes than patients with single intracranial occlusions, and intravenous thrombolysis is less effective in these patients. Although endovascular thrombectomy is currently a cornerstone therapy in the management of acute ischemic stroke due to large vessel occlusion, the optimal management of extracranial carotid lesions in tandem occlusion remains controversial. Acute placement of a stent in the cervical carotid artery lesion is the most used therapeutic strategy compared with stented balloon angioplasty and thrombectomy alone without carotid artery revascularization; however, treatment strategies in these patients are often more complex than with single occlusion, so treatment decisions can change based on clinical and technical considerations. The aim of this review is to analyze the results of different studies and trials, investigating the periprocedural neurointerventional management of patients with tandem lesions and the safety, efficacy of the different technical strategies available as well as their impact on the clinical outcome in these patients, to strengthen current recommendations and thus optimize patient care.http://www.sciencedirect.com/science/article/pii/S2352047723000394Acute Ischemic StrokeTandem lesionEndovascular ThrombectomyTandem OcclusionStenting |
| spellingShingle | Antonio Di Donna Gianluca Muto Flavio Giordano Massimo Muto Gianluigi Guarnieri Giovanna Servillo Antonio De Mase Emanuele Spina Giuseppe Leone Diagnosis and management of tandem occlusion in acute ischemic stroke European Journal of Radiology Open Acute Ischemic Stroke Tandem lesion Endovascular Thrombectomy Tandem Occlusion Stenting |
| title | Diagnosis and management of tandem occlusion in acute ischemic stroke |
| title_full | Diagnosis and management of tandem occlusion in acute ischemic stroke |
| title_fullStr | Diagnosis and management of tandem occlusion in acute ischemic stroke |
| title_full_unstemmed | Diagnosis and management of tandem occlusion in acute ischemic stroke |
| title_short | Diagnosis and management of tandem occlusion in acute ischemic stroke |
| title_sort | diagnosis and management of tandem occlusion in acute ischemic stroke |
| topic | Acute Ischemic Stroke Tandem lesion Endovascular Thrombectomy Tandem Occlusion Stenting |
| url | http://www.sciencedirect.com/science/article/pii/S2352047723000394 |
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