Logo image
Back
Effect of the Cervical Lesion Severity on Procedural and Clinical Outcomes after Endovascular Treatment of Acute Tandem Lesions: A Multicenter Study
Journal article   Open access   Peer reviewed

Effect of the Cervical Lesion Severity on Procedural and Clinical Outcomes after Endovascular Treatment of Acute Tandem Lesions: A Multicenter Study

Milagros Galecio-Castillo, Mudassir Farooqui, Ameer E. Hassan, Mouhammad A. Jumaa, Afshin A. Divani, Marc Ribo, Michael Abraham, Nils H. Petersen, Johanna T. Fifi, Waldo R. Guerrero, …
Stroke: vascular and interventional neurology, Vol.5(4), e001598
07/2025
DOI: 10.1161/SVIN.124.001598
PMCID: PMC12697657
PMID: 41573705
Appears in  UI Libraries Support Open Access
url
https://doi.org/10.1161/SVIN.124.001598View
Published (Version of record) Open Access

Abstract

Background Tandem lesions pose unique challenges in the endovascular treatment of acute ischemic stroke. We aimed to compare the clinical and procedural outcomes of patients with tandem lesions and extracranial internal carotid artery (ICA) complete occlusion versus those with moderate to severe stenosis. Methods This is a subanalysis of a multicenter cohort of patients with acute anterior circulation tandem lesions treated with intracranial mechanical thrombectomy and carotid artery stenting, between January 2015 and December 2020. The patients were categorized into 2 groups: extracranial ICA stenosis >70% to 99% and complete occlusion. Outcomes included successful and excellent recanalization, functional independence, symptomatic intracranial hemorrhage, and puncture‐to‐recanalization time. Sensitivity analyses were conducted based on varying degrees of stenosis, and we explored interactions with age, Alberta Stroke Program Early CT [Computed Tomography] Score, National Institutes of Health Stroke Scale, procedural antiplatelets, ICA treatment approach, ICA lesion etiology, Intravenous thrombolysis, and use of a balloon‐guide catheter. Results The study included 323 patients; 166 (51.4%) of whom presented with ICA occlusion and 157 (48.6%) with severe stenosis. Patients with ICA occlusion had significantly higher rates of previous stroke/transient ischemic attack, and antegrade ICA treatment approach. The comparison between both groups in univariable and multivariable analysis revealed no significant differences in the rates of successful and excellent recanalization, functional independence, symptomatic intracranial hemorrhage, and additional outcomes. The median puncture‐to‐recanalization time was longer in the occlusion group (adjusted coefficient, 1.21 [95% CI 1.01–1.46], P = 0.05). When categorized into 3 groups (occlusion, severe, and moderate stenosis), median puncture‐to‐recanalization time was significantly higher in patients with occlusion (adjusted coefficient, 1.34 [95% CI, 1.04–1.71], P = 0.022), and a trend toward statistical significance was observed in patients with severe stenosis (adjusted coefficient, 1.29 [95% CI, 0.98–1.71], P = 0.068), compared with patients with moderate stenosis. Interaction analysis did not yield significant differences. Conclusion In patients with tandem lesions, those with ICA occlusion presented longer puncture‐to‐recanalization time than patients with cervical stenosis. This observation might be linked to higher rates of an antegrade approach in patients with ICA occlusion.
 carotid artery stenting carotid occlusion carotid stenosis ischemic stroke mechanical thrombectomy UIOWA OA Agreement

Details

Metrics

3 Record Views
Logo image