Endovascular Treatment of Atherosclerotic Tandem Occlusions in Anterior Circulation Stroke: Technical Aspects and Complications Compared to Isolated Intracranial Occlusions
Background and Purpose: Endovascular treatment of tandem occlusions is an emerging option. We describe our multicenter experience with endovascular management of atherosclerotic tandem occlusions in the anterior circulation, particularly the technical aspects and complications in comparison to isola...
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2018-12-01
|
| Series: | Frontiers in Neurology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/article/10.3389/fneur.2018.01046/full |
| _version_ | 1818299437950173184 |
|---|---|
| author | Omer Faruk Eker Monika Bühlmann Cyril Dargazanli Johannes Kaesmacher Isabelle Mourand Jan Gralla Caroline Arquizan Urs Martin Fischer Gregory Gascou Mirjam Heldner Marcel Arnold Vincent Costalat Pasquale Mordasini |
| author_facet | Omer Faruk Eker Monika Bühlmann Cyril Dargazanli Johannes Kaesmacher Isabelle Mourand Jan Gralla Caroline Arquizan Urs Martin Fischer Gregory Gascou Mirjam Heldner Marcel Arnold Vincent Costalat Pasquale Mordasini |
| author_sort | Omer Faruk Eker |
| collection | DOAJ |
| description | Background and Purpose: Endovascular treatment of tandem occlusions is an emerging option. We describe our multicenter experience with endovascular management of atherosclerotic tandem occlusions in the anterior circulation, particularly the technical aspects and complications in comparison to isolated intracranial occlusions.Materials and Methods: Consecutive patients with tandem occlusions due to atherosclerotic causes who underwent mechanical thrombectomy at two major stroke centers between January 2010 and September 2015 were reviewed. Clinical data, procedural aspects, recanalization rates, complication rates, and clinical outcome were analyzed and compared to findings in patients with isolated intracranial occlusions.Results: One hundred and twenty-one patients with tandem occlusions and 456 patients with isolated intracranial occlusions (carotid-T/M1) were included. Mean intervention time was faster (33 min vs. 57 min, p < 0.001) and recanalization success was higher (TICI 2b/3 83.6 vs. 70.2%, p = 0.002) in patients with isolated occlusions. No difference was seen in clinical outcome and complications, except for a higher rate of asymptomatic hemorrhage in the tandem group (29.8 vs. 17.1%, p = 0.003). Choice of recanalization approach (antegrade vs. retrograde) in the tandem group made no difference, except for a trend toward less distal emboli using the retrograde approach (4.0 vs. 13.0%, p = 0.082). Stenting of the extracranial internal carotid artery (ICA) was performed in 81%, PTA alone in 7.4%, and deferred stenting in 11.6%. Rate of stent/ICA occlusion within 7 days was 10.3% after stenting and 33.3% after PTA (p = 0.127). In the tandem group, age (p = 0.034), National Institutes of Health Stroke Scale score (NIHSS) at admission (p = 0.002), recanalization rate (p < 0.001), complications (p = 0.016), and symptomatic intracranial hemorrhage (sICH) (p = 0.001) were associated with poor outcome, whereas extracranial treatment modality and stent/ICA occlusion within 7 days did not affect outcome.Conclusion: Endovascular treatment of tandem occlusions is technically feasible, achieves recanalization rates and rates of good clinical outcome comparable to those in patients with isolated intracranial occlusions. Following acute ICA stenting, the risk of stent occlusion and sICH appeared to be low, but was associated with an increased rate of asymptomatic ICH. |
| first_indexed | 2024-12-13T04:51:13Z |
| format | Article |
| id | doaj.art-801a97901e5a486db5d25b1f0bc73aa6 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-13T04:51:13Z |
| publishDate | 2018-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-801a97901e5a486db5d25b1f0bc73aa62022-12-21T23:59:00ZengFrontiers Media S.A.Frontiers in Neurology1664-22952018-12-01910.3389/fneur.2018.01046414791Endovascular Treatment of Atherosclerotic Tandem Occlusions in Anterior Circulation Stroke: Technical Aspects and Complications Compared to Isolated Intracranial OcclusionsOmer Faruk Eker0Monika Bühlmann1Cyril Dargazanli2Johannes Kaesmacher3Isabelle Mourand4Jan Gralla5Caroline Arquizan6Urs Martin Fischer7Gregory Gascou8Mirjam Heldner9Marcel Arnold10Vincent Costalat11Pasquale Mordasini12Department of Interventional and Diagnostic Neuroradiology, Montpellier University Hospital, Montpellier, FranceDepartment of Neurology, Inselspital, Bern University Hospital, Bern, SwitzerlandDepartment of Interventional and Diagnostic Neuroradiology, Montpellier University Hospital, Montpellier, FranceUniversity Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, Bern, SwitzerlandDepartment of Neurology, Montpellier University Hospital, Montpellier, FranceUniversity Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, Bern, SwitzerlandDepartment of Neurology, Montpellier University Hospital, Montpellier, FranceDepartment of Neurology, Inselspital, Bern University Hospital, Bern, SwitzerlandDepartment of Interventional and Diagnostic Neuroradiology, Montpellier University Hospital, Montpellier, FranceDepartment of Neurology, Inselspital, Bern University Hospital, Bern, SwitzerlandDepartment of Neurology, Inselspital, Bern University Hospital, Bern, SwitzerlandDepartment of Interventional and Diagnostic Neuroradiology, Montpellier University Hospital, Montpellier, FranceUniversity Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, Bern, SwitzerlandBackground and Purpose: Endovascular treatment of tandem occlusions is an emerging option. We describe our multicenter experience with endovascular management of atherosclerotic tandem occlusions in the anterior circulation, particularly the technical aspects and complications in comparison to isolated intracranial occlusions.Materials and Methods: Consecutive patients with tandem occlusions due to atherosclerotic causes who underwent mechanical thrombectomy at two major stroke centers between January 2010 and September 2015 were reviewed. Clinical data, procedural aspects, recanalization rates, complication rates, and clinical outcome were analyzed and compared to findings in patients with isolated intracranial occlusions.Results: One hundred and twenty-one patients with tandem occlusions and 456 patients with isolated intracranial occlusions (carotid-T/M1) were included. Mean intervention time was faster (33 min vs. 57 min, p < 0.001) and recanalization success was higher (TICI 2b/3 83.6 vs. 70.2%, p = 0.002) in patients with isolated occlusions. No difference was seen in clinical outcome and complications, except for a higher rate of asymptomatic hemorrhage in the tandem group (29.8 vs. 17.1%, p = 0.003). Choice of recanalization approach (antegrade vs. retrograde) in the tandem group made no difference, except for a trend toward less distal emboli using the retrograde approach (4.0 vs. 13.0%, p = 0.082). Stenting of the extracranial internal carotid artery (ICA) was performed in 81%, PTA alone in 7.4%, and deferred stenting in 11.6%. Rate of stent/ICA occlusion within 7 days was 10.3% after stenting and 33.3% after PTA (p = 0.127). In the tandem group, age (p = 0.034), National Institutes of Health Stroke Scale score (NIHSS) at admission (p = 0.002), recanalization rate (p < 0.001), complications (p = 0.016), and symptomatic intracranial hemorrhage (sICH) (p = 0.001) were associated with poor outcome, whereas extracranial treatment modality and stent/ICA occlusion within 7 days did not affect outcome.Conclusion: Endovascular treatment of tandem occlusions is technically feasible, achieves recanalization rates and rates of good clinical outcome comparable to those in patients with isolated intracranial occlusions. Following acute ICA stenting, the risk of stent occlusion and sICH appeared to be low, but was associated with an increased rate of asymptomatic ICH.https://www.frontiersin.org/article/10.3389/fneur.2018.01046/fullstrokeendovascular treatmenttandem occlusionthrombectomystenting |
| spellingShingle | Omer Faruk Eker Monika Bühlmann Cyril Dargazanli Johannes Kaesmacher Isabelle Mourand Jan Gralla Caroline Arquizan Urs Martin Fischer Gregory Gascou Mirjam Heldner Marcel Arnold Vincent Costalat Pasquale Mordasini Endovascular Treatment of Atherosclerotic Tandem Occlusions in Anterior Circulation Stroke: Technical Aspects and Complications Compared to Isolated Intracranial Occlusions Frontiers in Neurology stroke endovascular treatment tandem occlusion thrombectomy stenting |
| title | Endovascular Treatment of Atherosclerotic Tandem Occlusions in Anterior Circulation Stroke: Technical Aspects and Complications Compared to Isolated Intracranial Occlusions |
| title_full | Endovascular Treatment of Atherosclerotic Tandem Occlusions in Anterior Circulation Stroke: Technical Aspects and Complications Compared to Isolated Intracranial Occlusions |
| title_fullStr | Endovascular Treatment of Atherosclerotic Tandem Occlusions in Anterior Circulation Stroke: Technical Aspects and Complications Compared to Isolated Intracranial Occlusions |
| title_full_unstemmed | Endovascular Treatment of Atherosclerotic Tandem Occlusions in Anterior Circulation Stroke: Technical Aspects and Complications Compared to Isolated Intracranial Occlusions |
| title_short | Endovascular Treatment of Atherosclerotic Tandem Occlusions in Anterior Circulation Stroke: Technical Aspects and Complications Compared to Isolated Intracranial Occlusions |
| title_sort | endovascular treatment of atherosclerotic tandem occlusions in anterior circulation stroke technical aspects and complications compared to isolated intracranial occlusions |
| topic | stroke endovascular treatment tandem occlusion thrombectomy stenting |
| url | https://www.frontiersin.org/article/10.3389/fneur.2018.01046/full |
| work_keys_str_mv | AT omerfarukeker endovasculartreatmentofatherosclerotictandemocclusionsinanteriorcirculationstroketechnicalaspectsandcomplicationscomparedtoisolatedintracranialocclusions AT monikabuhlmann endovasculartreatmentofatherosclerotictandemocclusionsinanteriorcirculationstroketechnicalaspectsandcomplicationscomparedtoisolatedintracranialocclusions AT cyrildargazanli endovasculartreatmentofatherosclerotictandemocclusionsinanteriorcirculationstroketechnicalaspectsandcomplicationscomparedtoisolatedintracranialocclusions AT johanneskaesmacher endovasculartreatmentofatherosclerotictandemocclusionsinanteriorcirculationstroketechnicalaspectsandcomplicationscomparedtoisolatedintracranialocclusions AT isabellemourand endovasculartreatmentofatherosclerotictandemocclusionsinanteriorcirculationstroketechnicalaspectsandcomplicationscomparedtoisolatedintracranialocclusions AT jangralla endovasculartreatmentofatherosclerotictandemocclusionsinanteriorcirculationstroketechnicalaspectsandcomplicationscomparedtoisolatedintracranialocclusions AT carolinearquizan endovasculartreatmentofatherosclerotictandemocclusionsinanteriorcirculationstroketechnicalaspectsandcomplicationscomparedtoisolatedintracranialocclusions AT ursmartinfischer endovasculartreatmentofatherosclerotictandemocclusionsinanteriorcirculationstroketechnicalaspectsandcomplicationscomparedtoisolatedintracranialocclusions AT gregorygascou endovasculartreatmentofatherosclerotictandemocclusionsinanteriorcirculationstroketechnicalaspectsandcomplicationscomparedtoisolatedintracranialocclusions AT mirjamheldner endovasculartreatmentofatherosclerotictandemocclusionsinanteriorcirculationstroketechnicalaspectsandcomplicationscomparedtoisolatedintracranialocclusions AT marcelarnold endovasculartreatmentofatherosclerotictandemocclusionsinanteriorcirculationstroketechnicalaspectsandcomplicationscomparedtoisolatedintracranialocclusions AT vincentcostalat endovasculartreatmentofatherosclerotictandemocclusionsinanteriorcirculationstroketechnicalaspectsandcomplicationscomparedtoisolatedintracranialocclusions AT pasqualemordasini endovasculartreatmentofatherosclerotictandemocclusionsinanteriorcirculationstroketechnicalaspectsandcomplicationscomparedtoisolatedintracranialocclusions |