Endovascular treatment of acute ischemic stroke patients with tandem lesions: antegrade versus retrograde approach

被引：0

作者：

Galecio-Castillo, Milagros ^{[1
]}

Abraham, Michael ^{[2
]}

Farooqui, Mudassir ^{[1
]}

Hassan, Ameer E. ^{[3
]}

Divani, Afshin A. ^{[4
]}

Jumaa, Mouhammad A. ^{[5
]}

Ribo, Marc ^{[6
]}

Petersen, Nils ^{[7
]}

Fifi, Johanna ^{[8
]}

Guerrero, Waldo R. ^{[9
]}

Malik, Amer M. ^{[10
]}

Siegler, James E. ^{[11
,12
]}

Nguyen, Thanh N. ^{[13
]}

Sheth, Sunil A. ^{[14
]}

Yoo, Albert J. ^{[15
]}

Linares, Guillermo ^{[16
]}

Janjua, Nazli ^{[17
]}

Quispe-Orozco, Darko ^{[1
]}

Qureshi, Abid ^{[2
]}

Tekle, Wondwossen G. ^{[3
]}

Ikram, Asad ^{[4
]}

Zaidi, Syed F. ^{[5
]}

Zevallos, Cynthia B. ^{[1
]}

Taborda, Belen ^{[6
]}

Devarajan, Alex ^{[8
]}

Zhang, Linda ^{[12
]}

Abdalkader, Mohamad ^{[13
]}

Salazar-Marioni, Sergio ^{[14
]}

Soomro, Jazba ^{[15
]}

Gordon, Weston ^{[16
]}

Rodriguez-Calienes, Aaron ^{[1
,18
]}

Vivanco-Suarez, Juan ^{[1
]}

Woolfolk, Katrina ^{[17
]}

Mokin, Maxim ^{[9
]}

Yavagal, Dileep R. ^{[10
]}

Ortega-Gutierrez, Santiago ^{[1
]}

机构：

[1] Univ Iowa Hosp & Clin, Dept Neurol, Iowa City, IA USA

[2] Univ Kansas, Med Ctr, Dept Neurol, Kansas City, KS USA

[3] Univ Texas Rio Grande Valley, Valley Baptist Med Ctr, Dept Neurol, Harlingen, TX USA

[4] Univ New Mexico, Hlth Sci Ctr, Dept Neurol, Albuquerque, NM USA

[5] ProMed Toledo Hosp, Dept Neurol, Toledo, OH USA

[6] Univ Hosp Vall dHebron, Dept Neurol, Barcelona, Spain

[7] Yale Univ, Sch Med, Dept Neurol, New Haven, CT USA

[8] Icahn Sch Med Mt Sinai, Dept Neurosurg, New York, NY USA

[9] Univ S Florida, Dept Neurol & Brain Repair, Tampa, FL USA

[10] Univ Miami, Miller Sch Med, Dept Neurol, Miami, FL USA

[11] Cooper Univ Hosp, Cooper Neurol Inst, Camden, NJ USA

[12] Rowan Univ, Cooper Med Sch, Camden, NJ USA

[13] Boston Med Ctr, Dept Neurol, Boston, MA USA

[14] UT Hlth McGovern Med Sch, Dept Neurol, Houston, TX USA

[15] Texas Stroke Inst, Ft Worth, TX USA

[16] St Louis Univ, Dept Neurol, St Louis, MO USA

[17] Pomona Valley Hosp Med Ctr, Pomona, CA USA

[18] Univ Cient Sur, Dept Neurosci, Clin Effectiveness & Publ Hlth Res Grp, Lima, Peru

来源：

JOURNAL OF NEUROSURGERY | 2024年 / 140卷 / 06期

基金：

美国国家卫生研究院;

关键词：

ischemic stroke; tandem lesions; carotid artery; thrombectomy; intervention; endovascular neurosurgery; vascular disorders; ARTERY OCCLUSION; THROMBECTOMY; GUIDELINES; MANAGEMENT;

D O I：

10.3171/2023.10.JNS231702

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

OBJECTIVE The optimal technique for treating tandem lesions (TLs) with endovascular therapy is debatable. The authors evaluated the functional, safety, and procedural outcomes of different approaches in a multicenter study. METHODS Anterior circulation TL patients treated from January 2015 to December 2020 were divided on the basis of antegrade versus retrograde approach and included. The evaluated outcomes were favorable modified Rankin Scale (mRS) score (mRS score 0-2) at 3 months, ordinal shift in mRS score, successful recanalization, excellent recanalization, first-pass effect (FPE), time from groin puncture to successful recanalization, symptomatic intracranial hemorrhage (sICH), and 90-day mortality. RESULTS Among 691 patients treated at 16 centers, 286 patients (174 antegrade and 112 retrograde approach patients) with acute stenting were included in the final analysis. There were no significant differences in mRS score 0-2 at 90 days (52.2% vs 50.0%, adjusted odds ratio [aOR] 0.83, 95% CI 0.42-1.56, p = 0.54), favorable shift in 90-day mRS score (aOR 1.03, 95% CI 0.66-1.29, p = 0.11), sICH (4.0% vs 4.5%, aOR 0.64, 95% CI 0.24-1.51, p = 0.45), successful recanalization (89.4% vs 93%, aOR 0.49, 95% CI 0.19-1.28, p = 0.19), excellent recanalization (51.4% vs 58.9%, aOR 0.59, 95% CI 0.40-1.07, p = 0.09), FPE (58.3% vs 69.7%, aOR 0.62, 95% CI 0.44-1.15, p = 0.21), and mortality at 90 days (16.6% vs 14.0%, aOR 0.94, 95% CI 0.35-2.44, p = 0.81) between the groups. The median (interquartile range) groin puncture to recanalization time was significantly longer in the antegrade group (59 [43-90] minutes vs 49 [35-73] minutes, p = 0.036). CONCLUSIONS The retrograde approach was associated with faster recanalization times with a similar functional and safety profile when compared with the antegrade approach in patients with acute ischemic stroke with TL. https://thejns.org/doi/abs/10.3171/2023.10.JNS231702

引用

页码：1726 / 1735

页数：10

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