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The “distal-to-proximal” strategy for the treatment of posterior circulation tandem occlusions: a single-centre experience

  • Interventional Neuroradiology
  • Published:
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Abstract

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.

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Acknowledgments

We are grateful to the clinicians and staff at the Changhai Hospital of Second Military Medical University for their contribution to medical intervention and data collection.

Funding

This study was funded by the Project of Research and Application of Effective Intervention Techniques for High-Risk Stroke Population of China in 2017 (GN-2017R0001).

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Author notes

  1. P-fX and Y-wZ contributed equally to this work.

Authors and Affiliations

  1. Department of Stroke Center, Changhai Hospital, Second Military Medical University, No.168 Changhai Rd, Shanghai, 200433, China

    Peng-fei Xing, Yong-wei Zhang & Hong-jian Shen

  2. Department of Neurosurgery, Changhai Hospital, Second Military Medical University, No.168 Changhai Rd, Shanghai, 200433, China

    Zi-fu Li, Lei Zhang, Yong-xin Zhang, Yi-bin Fang, Rui Zhao, Qiang Li, Qing-hai Huang, Bo Hong, Yi Xu, Peng-fei Yang & Jian-min Liu

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  1. Peng-fei Xing
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Correspondence to Jian-min Liu.

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Xing, Pf., Zhang, Yw., Li, Zf. et al. The “distal-to-proximal” strategy for the treatment of posterior circulation tandem occlusions: a single-centre experience. Neuroradiology 62, 867–876 (2020). https://doi.org/10.1007/s00234-020-02412-0

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