Endovascular Thrombectomy in Patients With Acute Ischemic Stroke With Simultaneous Multivessel Occlusions
Background Simultaneous multivessel occlusions (MVOs) are a rare condition, which may be encountered during endovascular thrombectomy (EVT) for acute ischemic stroke. This study aimed to investigate the prevalence, associated factors, and outcome of patients with acute ischemic stroke and MVO who un...
| Κύριοι συγγραφείς: | , , , , , , , , , |
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| Μορφή: | Άρθρο |
| Γλώσσα: | English |
| Έκδοση: |
Wiley
2022-05-01
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| Σειρά: | Stroke: Vascular and Interventional Neurology |
| Θέματα: | |
| Διαθέσιμο Online: | https://www.ahajournals.org/doi/10.1161/SVIN.121.000228 |
| _version_ | 1827393711851438080 |
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| author | Chi‐Ting Chung Chih‐Hao Chen Hai‐Jui Chu Yu‐Ming Chang Pi‐Shan Sung Yen‐Heng Lin Chung‐Wei Lee Li‐Kai Tsai Sung‐Chun Tang Jiann‐Shing Jeng |
| author_facet | Chi‐Ting Chung Chih‐Hao Chen Hai‐Jui Chu Yu‐Ming Chang Pi‐Shan Sung Yen‐Heng Lin Chung‐Wei Lee Li‐Kai Tsai Sung‐Chun Tang Jiann‐Shing Jeng |
| author_sort | Chi‐Ting Chung |
| collection | DOAJ |
| description | Background Simultaneous multivessel occlusions (MVOs) are a rare condition, which may be encountered during endovascular thrombectomy (EVT) for acute ischemic stroke. This study aimed to investigate the prevalence, associated factors, and outcome of patients with acute ischemic stroke and MVO who underwent EVT. Methods Consecutive patients with acute ischemic stroke who received EVT between September 2014 and April 2021 were included. Acute MVO was defined as simultaneous occlusions of ≥2 intracranial or extracranial major vessels in either bilateral anterior circulation or anterior plus posterior circulation. Patients’ baseline characteristics and outcome of MVO were analyzed. Results Of 602 patients with acute ischemic stroke (mean age, 71±13 years; male, 53.1%) who received EVT, 11 patients (1.8%) had acute MVO. The involved vessels included bilateral internal carotid arteries in 3, bilateral middle cerebral arteries in 4, vertebral artery and distal middle cerebral artery in 1, and internal carotid artery and distal posterior cerebral artery in 3 patients. Preadmission dependence (modified Rankin scale score >2), higher initial stroke severity, and posterior cerebral artery occlusion were more frequently found in MVO. The cause of MVO included large vessel atherosclerosis in 4, cardioembolic in 4, cancer‐related hypercoagulability in 2, and postpartum in 1 patient. Several patients had received simultaneous multitargeted EVT, but only 4 of them achieved optimal reperfusion in both vessels. Compared with patients without MVO, those with MVO had higher mortality (adjusted odds ratio, 6.75; 95% CI, 1.93–23.6) and poor functional outcome (common odds ratio for 1‐point improvement at modified Rankin scale, 0.14, 95% CI, 0.05–0.45) at 90 days. Conclusion Acute simultaneous MVO in patients who underwent EVT is a rare yet devastating condition. Multitarget mechanical thrombectomy to achieve reperfusion is challenging but still possible. |
| first_indexed | 2024-03-08T17:54:18Z |
| format | Article |
| id | doaj.art-7875e6d1bfc74a419930ad22d12974ac |
| institution | Directory Open Access Journal |
| issn | 2694-5746 |
| language | English |
| last_indexed | 2024-03-08T17:54:18Z |
| publishDate | 2022-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Stroke: Vascular and Interventional Neurology |
| spelling | doaj.art-7875e6d1bfc74a419930ad22d12974ac2024-01-02T05:44:18ZengWileyStroke: Vascular and Interventional Neurology2694-57462022-05-012310.1161/SVIN.121.000228Endovascular Thrombectomy in Patients With Acute Ischemic Stroke With Simultaneous Multivessel OcclusionsChi‐Ting Chung0Chih‐Hao Chen1Hai‐Jui Chu2Yu‐Ming Chang3Pi‐Shan Sung4Yen‐Heng Lin5Chung‐Wei Lee6Li‐Kai Tsai7Sung‐Chun Tang8Jiann‐Shing Jeng9Department of Neurology National Taiwan University Hospital Taipei TaiwanDepartment of Neurology National Taiwan University Hospital Taipei TaiwanDepartment of Neurology En Chu Kong Hospital New Taipei City TaiwanDepartment of Neurology, National Cheng Kung University Hospital College of Medicine National Cheng Kung University Tainan TaiwanDepartment of Neurology, National Cheng Kung University Hospital College of Medicine National Cheng Kung University Tainan TaiwanDepartment of Medical Imaging National Taiwan University Hospital Taipei TaiwanDepartment of Medical Imaging National Taiwan University Hospital Taipei TaiwanDepartment of Neurology National Taiwan University Hospital Taipei TaiwanDepartment of Neurology National Taiwan University Hospital Taipei TaiwanDepartment of Neurology National Taiwan University Hospital Taipei TaiwanBackground Simultaneous multivessel occlusions (MVOs) are a rare condition, which may be encountered during endovascular thrombectomy (EVT) for acute ischemic stroke. This study aimed to investigate the prevalence, associated factors, and outcome of patients with acute ischemic stroke and MVO who underwent EVT. Methods Consecutive patients with acute ischemic stroke who received EVT between September 2014 and April 2021 were included. Acute MVO was defined as simultaneous occlusions of ≥2 intracranial or extracranial major vessels in either bilateral anterior circulation or anterior plus posterior circulation. Patients’ baseline characteristics and outcome of MVO were analyzed. Results Of 602 patients with acute ischemic stroke (mean age, 71±13 years; male, 53.1%) who received EVT, 11 patients (1.8%) had acute MVO. The involved vessels included bilateral internal carotid arteries in 3, bilateral middle cerebral arteries in 4, vertebral artery and distal middle cerebral artery in 1, and internal carotid artery and distal posterior cerebral artery in 3 patients. Preadmission dependence (modified Rankin scale score >2), higher initial stroke severity, and posterior cerebral artery occlusion were more frequently found in MVO. The cause of MVO included large vessel atherosclerosis in 4, cardioembolic in 4, cancer‐related hypercoagulability in 2, and postpartum in 1 patient. Several patients had received simultaneous multitargeted EVT, but only 4 of them achieved optimal reperfusion in both vessels. Compared with patients without MVO, those with MVO had higher mortality (adjusted odds ratio, 6.75; 95% CI, 1.93–23.6) and poor functional outcome (common odds ratio for 1‐point improvement at modified Rankin scale, 0.14, 95% CI, 0.05–0.45) at 90 days. Conclusion Acute simultaneous MVO in patients who underwent EVT is a rare yet devastating condition. Multitarget mechanical thrombectomy to achieve reperfusion is challenging but still possible.https://www.ahajournals.org/doi/10.1161/SVIN.121.000228acute ischemic strokeendovascular thrombectomymultivessel occlusionoutcome |
| spellingShingle | Chi‐Ting Chung Chih‐Hao Chen Hai‐Jui Chu Yu‐Ming Chang Pi‐Shan Sung Yen‐Heng Lin Chung‐Wei Lee Li‐Kai Tsai Sung‐Chun Tang Jiann‐Shing Jeng Endovascular Thrombectomy in Patients With Acute Ischemic Stroke With Simultaneous Multivessel Occlusions Stroke: Vascular and Interventional Neurology acute ischemic stroke endovascular thrombectomy multivessel occlusion outcome |
| title | Endovascular Thrombectomy in Patients With Acute Ischemic Stroke With Simultaneous Multivessel Occlusions |
| title_full | Endovascular Thrombectomy in Patients With Acute Ischemic Stroke With Simultaneous Multivessel Occlusions |
| title_fullStr | Endovascular Thrombectomy in Patients With Acute Ischemic Stroke With Simultaneous Multivessel Occlusions |
| title_full_unstemmed | Endovascular Thrombectomy in Patients With Acute Ischemic Stroke With Simultaneous Multivessel Occlusions |
| title_short | Endovascular Thrombectomy in Patients With Acute Ischemic Stroke With Simultaneous Multivessel Occlusions |
| title_sort | endovascular thrombectomy in patients with acute ischemic stroke with simultaneous multivessel occlusions |
| topic | acute ischemic stroke endovascular thrombectomy multivessel occlusion outcome |
| url | https://www.ahajournals.org/doi/10.1161/SVIN.121.000228 |
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