Annals of Indian Academy of Neurology
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Year : 2020  |  Volume : 23  |  Issue : 1  |  Page : 78-83

Endovascular Treatment for Acute Tandem Occlusion Stroke: Results from Case Series of 17 Patients

1 Radiology Faculty, Hanoi Medical University; Radiology Center, Bach Mai University Hospital, Danang, Vietnam
2 Radiology Center, Bach Mai University Hospital, Danang, Vietnam
3 Radiology Faculty, Hanoi Medical University, Danang, Vietnam
4 Institute for Research and Development, Duy Tan University, Danang, Vietnam
5 Faculty of Biology, Hanoi National University of Education, Hanoi, Vietnam

Correspondence Address:
Dr. Dinh-Toi Chu
Faculty of Biology, Hanoi National University of Education, Hanoi
Dr. Thien Chu-Dinh
Institute for Research and Development, Duy Tan University, Danang
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aian.AIAN_464_18

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Background and Purpose: Tandem occlusive lesion, a major challenge for thrombectomy in acute anterior circulation strokes, is poorly represented in randomized trials. This study demonstrates the findings of thrombectomy in tandem occlusion and comparative analysis of two treatment groups (extracranial versus intracranial first subgroup). Patients and Methods: We enrolled and divided 17 patients with acute tandem ischemic stroke who received endovascular treatment into two groups. Group 1 with completed (100%) internal carotid artery (ICA) occlusion was treated by an extracranial stent, whereas Group 2 with severe (70%–99%) ICA occlusion was prioritized with intracranial thrombectomy. Data of clinical parameters, imaging and angiographic results, periprocedural complications, and results after 3 months were collected and analyzed. Results: The mean age of patients was 70.2 ± 8.8 years, and males accounted for 94.1%. The National Institutes of Health Stroke Scale and Alberta Stroke Program Early CT Score (ASPECTS) baseline were 16.6 ± 4.2 and 7.6 ± 1.1, respectively, with occlusive side was 52.9% on the right. Group 1 including ten cases (58.8%) was treated extracranial lesion with carotid stent before intracranial thrombectomy, and Group 2 with seven cases (41.2%) was prioritized intracranial thrombectomy. In total 17 procedures, there were ten stent retrievers (58.8%), four aspirations (23.5%), and three Solumbra (17.7%). No re-occlusion of carotid stent postoperation was recorded. The good revascularization (thrombolysis in cerebral infarction 2b-3) was archived in 82.4% of patients, while symptomatic hemorrhage was seen in 2 cases (11.8%). Three months after treatment, patients with favorable clinical outcome (Modified Rankin Scale ≤2) accounted for 47.1%. Conclusion: Our study determined a promising outcome with reasonable good recanalization and clinical recovery for endovascular intervention in tandem ischemic. In the subgroup of treatment, “extracranial stent first” had more complex disease with completed ICA occlusion which required longer procedure time may lead to worse outcome.

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