Thrombectomy in ischemic stroke patients with tandem occlusion in the posterior versus anterior circulation.

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  • Additional Information
    • Corporate Authors:
      IRETAS group
    • Source:
      Publisher: Springer-Verlag Italia Country of Publication: Italy NLM ID: 100959175 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1590-3478 (Electronic) Linking ISSN: 15901874 NLM ISO Abbreviation: Neurol Sci Subsets: MEDLINE
    • Publication Information:
      Original Publication: Milano, Italy : Springer-Verlag Italia, c2000-
    • Subject Terms:
      Ischemic Stroke*/surgery ; Ischemic Stroke*/therapy ; Thrombectomy*/methods ; Registries*; Humans ; Male ; Female ; Aged ; Middle Aged ; Aged, 80 and over ; Cohort Studies ; Endovascular Procedures/methods ; Italy ; Treatment Outcome ; Prospective Studies
    • Abstract:
      Background: Mechanical thrombectomy (MT) was found to be beneficial in acute ischemic stroke patients with anterior tandem occlusion (a-TO). Instead, little is known about the effectiveness of MT in stroke patients with posterior tandem occlusion (p-TO). We aimed to compare MT within 24 h from last known well time in ischemic stroke patients with p-TO versus a-TO.
      Methods: We conducted a cohort study on prospectively collected data of patients registered in the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) who were treated with MT within 24 h from last known well time for acute ischemic stroke with p-TO (n = 275) or a-TO (n = 1853).
      Results: After adjustment for unbalanced pre-procedure variables (year 2015-2021, age, sex, NIHSS score, ASPECTS, and time strata for puncture groin) and pre-stroke mRS score as pre-defined predictor, p-TO was significantly associated with lower probability of mRS score 0-2 (OR 0.415, 95% CI 0.268-0.644) and with higher risk of death (OR 2.813, 95% CI 2.080-3.805) at 3 months. After adjustment for unbalanced procedural and post-procedure variables (IVT, general anesthesia, TICI 3, and 24-h HT) and pre-stroke mRS score as pre-defined predictor, association between p-TO and lower probability of mRS score 0-2 (OR 0.444, 95% CI 0.304-0.649) and association between p-TO and with higher risk of death (OR 2.971, 95% CI 1.993-4.429) remained significant.
      Conclusions: MT within 24 h from last known well time in ischemic stroke patients with p-TO versus a-TO was associated with worse outcomes at 3 months.
      (© 2024. Fondazione Società Italiana di Neurologia.)
    • References:
      Weinberg JH, Sweid A, Sajja K et al (2020) Posterior circulation tandem occlusions: Classification and techniques. Clin Neurol Neurosurg 198:106154. (PMID: 10.1016/j.clineuro.2020.10615432829201)
      Goyal M, Menon BK, van Zwam WH, et al (2016) HERMES collaborators. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 387:1723-173.
      Feil K, Herzberg M, Dorn F et al (2021) Tandem Lesions in Anterior Circulation Stroke: Analysis of the German Stroke Registry-Endovascular Treatment. Stroke 52:1265–1275. (PMID: 10.1161/STROKEAHA.120.03179733588589)
      Baik SH, Jung C, Byung Moon Kim BM et al (2020) Mechanical Thrombectomy for Tandem Vertebrobasilar Stroke. Stroke 51:1883–1885. (PMID: 10.1161/STROKEAHA.120.02950332404041)
      Liang K, Wang B, Linbo Zhao L et al (2022) Management of posterior circulation tandem occlusions in acute ischemic stroke: Recanalize the dominant vertebral artery with priority. Interv Neuroradiol 25:15910199221111710.
      Mangiafico S, Pracucci G, Saia V et al (2015) The Italian Regstry of Endovascular Treatment in Acute Stroke: rationale, design and baseline features of patients. Neurol Sci 36:985–993. (PMID: 10.1007/s10072-014-2053-525567080)
      Adusumilli G, Pederson JM, Hardy N et al (2022) Mechanical thrombectomy in anterior vs. posterior circulation stroke A systematic review and meta-analysis. Interv Neuroradiol 13:15910199221100796.
      Nogueira RG, Jadhav AP, Haussen DC et al (2018) Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 378:11–21. (PMID: 10.1056/NEJMoa170644229129157)
      Jovin TG, Li C, Wu L et al (2022) Trial of Thrombectomy 6 to 24 Hours after Stroke Due to Basilar-Artery Occlusion. N Engl J Med 387:1373–1384. (PMID: 10.1056/NEJMoa220757636239645)
      Keselman B, Gdovinová Z, Jatuzis D et al (2020) Safety and Outcomes of Intravenous Thrombolysis in Posterior Versus Anterior Circulation Stroke Results From the Safe Implementation of Treatments in Stroke Registry and Meta-Analysis. Stroke 51:876–882. (PMID: 10.1161/STROKEAHA.119.02707131914885)
    • Contributed Indexing:
      Keywords: Anterior LVO; Posterior LVO; Stroke; Tandem occlusion; Thrombectomy
    • Publication Date:
      Date Created: 20240618 Date Completed: 20241012 Latest Revision: 20241012
    • Publication Date:
      20241013
    • Accession Number:
      10.1007/s10072-024-07638-x
    • Accession Number:
      38890169