Introduction: Acute ischemic strokes with tandem occlusions, which represent 10–20% of all ischemic strokes, have a particularly poor prognosis. Since emergent treatment of tandem lesions has not been specifically addressed in randomized trials, there is an absence of standardized management. Objective: We sought to assess the efficacy and safety of acute endovascular treatment in stroke due to tandem occlusions in our center and compare the results with previous reports. Methods: From a prospective registry we analyzed data of 99 consecutive patients (males: 77.7%, mean age ± SD: 67.5 ± 9.5 years) with stroke due to tandem occlusions who underwent treatment with emergent carotid stenting and intracranial mechanical thrombectomy. Successful recanalization was defined as a TICI score of 2b-3 and a good functional outcome was defined as a modified Rankin scale score ≤2 at 90 days. Symptomatic intracranial hemorrhage (sICH) was considered when associated with worsening on the National Institutes of Health Stroke Scale (≥4 points). Results: A successful recanalization rate was achieved in 87.8 and 48.5% of the patients had a good functional outcome. sICH and mortality rates were 12.1 and 20.2%, respectively, and 21.2% of the patients received combined treatment with intravenous thrombolysis, which did not affect neither the prognosis nor the recanalization or sICH rates. The time from symptom onset to recanalization and the degree of recanalization were the main factors associated with prognosis and the occurrence of sICH. Conclusions: Our results suggest that endovascular treatment with emergent carotid stenting and intracranial thrombectomy in patients with acute stroke due to tandem occlusions is an effective and safe procedure.
Cerebrovasc Dis Extra 2020;10:50–58

中文翻译：

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急性串联颈动脉阻塞的腔内治疗的疗效和安全性：单中心队列的分析。

简介：急性缺血性卒中并发阻塞，占所有缺血性卒中的10–20％，预后特别差。由于在随机试验中尚未明确解决串联损伤的紧急治疗，因此缺乏标准化的治疗方法。目的：我们试图在我们的中心评估因串联阻塞导致的急性血管内治疗在卒中中的有效性和安全性，并将结果与​​以前的报告进行比较。方法：从前瞻性注册表中，我们分析了99例因串联闭塞而接受了急诊颈动脉支架置入和颅内机械血栓切除术治疗的卒中的连续患者（男性：77.7％，平均年龄±SD：67.5±9.5岁）的数据。再通成功定义为TICI评分为2b-3，良好的功能预后定义为90天时经改良的Rankin量表评分≤2。在美国国立卫生研究院卒中量表（≥4分）上，症状性颅内出血（sICH）与病情加重相关。结果：87.8例患者实现了成功的再通率，并且48.5％的患者功能恢复良好。sICH和死亡率分别为12.1％和20.2％，21.2％的患者接受静脉溶栓治疗，这既不影响预后，也不影响再通或sICH率。从症状发作到再通的时间以及再通的程度是与预后和sICH发生有关的主要因素。结论：我们的结果表明，对于因串联阻塞而导致的急性中风患者，紧急颈动脉支架置入术和颅内血栓切除术进行血管内治疗是一种安全有效的方法。
Cerebrovasc Dis Extra 2020; 10：50–58