Purpose

Data on posterior circulation tandem occlusions in acute ischemic stroke are scarce: recognition may be challenging and little is known about optimal treatment strategy. We report our endovascular treatment strategy for posterior circulation tandem occlusion.

Methods

Consecutive patients with posterior circulation tandem occlusions in our centre were enrolled retrospectively. The preferred strategy was “distal-to-proximal” strategy, which means opening the distal occlusion first followed by treatment of the proximal pathology. The imaging characteristics, treatment strategy, clinical outcomes, and complications of patients with posterior circulation tandem occlusions were analyzed.

Results

In total, 21 patients with posterior circulation tandem occlusions were enrolled in the study, which accounted for 23.6% of patients with posterior circulation stroke in our centre. The mean age was 60 years (range 32 to 80), and median pre-procedure NIHSS score was 28 (interquartile range: 13–31). Eighteen patients (85.7%) had vertebrobasilar artery tandem occlusions and 3 (14.3%) had basilar artery to basilar artery tandem occlusions. All distal occlusions were successfully recanalized (modified TICI 2b/3). Two (9.5%) of the proximal lesions were not treated. A total of 57.1% of the patients had stents implanted on the proximal occlusions. The rate of mRS 0–3 at 3 months was 57.1% and the mortality rate was 19.0%.

Conclusion

In patients with acute ischaemic stroke caused by posterior circulation tandem occlusions, we favor “distal-to-proximal” strategy based on the positive results in this small series. Nevertheless, a more extensive study is required to explore the optimal treatment strategy further.

中文翻译：

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治疗后循环串联阻塞的“从远端到近端”策略：单中心体验。

目的

关于急性缺血性中风后循环串联闭塞的数据很少：认识可能是具有挑战性的，关于最佳治疗策略的了解很少。我们报告了后循环串联闭塞的血管内治疗策略。

方法

回顾性分析本中心连续进行后循环串联闭塞的患者。首选策略是“从远端到近端”策略，这意味着先打开远端闭塞，然后再治疗近端病理。分析了后循环串联闭塞患者的影像学特征，治疗策略，临床结局和并发症。

结果

本研究共纳入21例后循环串联闭塞患者，占本中心后循环卒中患者的23.6％。平均年龄为60岁（32至80岁），术前NIHSS评分中位数为28（四分位间距：13-31）。十八例（85.7％）患有椎基底动脉串联闭塞，3例（14.3％）患有基底动脉至基底动脉串联闭塞。所有远端阻塞均已成功再通（改良TICI 2b / 3）。未治疗两个（9.5％）近端病变。共有57.1％的患者在近端闭塞处植入了支架。3个月时mRS 0–3的发生率为57.1％，死亡率为19.0％。

结论

对于由后循环串联闭塞引起的急性缺血性卒中患者，基于这一小系列研究的阳性结果，我们倾向于“从远端到近端”的治疗策略。尽管如此，仍需要进行更广泛的研究以进一步探索最佳治疗策略。