Abstract
Purpose To evaluate outcomes and prognostic factors in patients with acute ischemic stroke caused by tandem internal carotid artery/middle cerebral artery occlusion undergoing endovascular treatment. Materials and Methods Characteristics of consecutive patients with tandem occlusion (TO) were extracted from a prospective registry. Collateral vessel quality on pretreatment computed tomographic (CT) angiography was evaluated on a 4-point grading scale, and patients were dichotomized as having poor or good collateral flow. Outcome measures included successful reperfusion according to Thrombolysis In Cerebral Infarction score, good outcome at 3 months defined as a modified Rankin scale score ≤ 2, symptomatic intracranial hemorrhage (ICH; sICH), and mortality. Results A total of 72 patients with TO (mean age, 65.6 y ± 12.8) were treated. Intravenous thrombolysis was performed in 54.1% of patients, and a carotid stent was inserted in 48.6%. Successful reperfusion was achieved in 64% of patients, and a good outcome was achieved in 32%. sICH occurred in 12.5% of patients, and the overall mortality rate was 32%. Univariate analysis demonstrated that good outcome was associated with good collateral flow (P = .0001), successful reperfusion (P = .001), and lower rate of any ICH (P = .02) and sICH (P = .04). On multivariate analysis, good collateral flow (odds ratio [OR], 0.18; 95% confidence interval [CI], 0.04–0.75; P = .01) and age (OR, 1.08; 95% CI, 1.01–1.15; P = .01) were the only predictors of good outcome. The use of more than one device for thrombectomy was the only predictor of sICH (OR, 10.74; 95% CI, 1.37–84.13; P = .02). Conclusions Endovascular treatment for TO resulted in good outcomes. Collateral flow and age were independent predictors of good clinical outcomes at 3 months.
| Original language | English |
|---|---|
| Pages (from-to) | 543-549 |
| Number of pages | 7 |
| Journal | Journal of Vascular and Interventional Radiology |
| Volume | 28 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Apr 1 2017 |
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ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging
- Cardiology and Cardiovascular Medicine
Cite this
Endovascular Stroke Treatment of Acute Tandem Occlusion : A Single-Center Experience. / Sallustio, Fabrizio; Motta, Caterina; Koch, Giacomo; Pizzuto, Silvia; Campbell, Bruce C.V.; Diomedi, Marina; Rizzato, Barbara; Davoli, Alessandro; Loreni, Giorgio; Konda, Daniel; Stefanini, Matteo; Fabiano, Sebastiano; Pampana, Enrico; Stanzione, Paolo; Gandini, Roberto.
In: Journal of Vascular and Interventional Radiology, Vol. 28, No. 4, 01.04.2017, p. 543-549.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Endovascular Stroke Treatment of Acute Tandem Occlusion
T2 - A Single-Center Experience
AU - Sallustio, Fabrizio
AU - Motta, Caterina
AU - Koch, Giacomo
AU - Pizzuto, Silvia
AU - Campbell, Bruce C.V.
AU - Diomedi, Marina
AU - Rizzato, Barbara
AU - Davoli, Alessandro
AU - Loreni, Giorgio
AU - Konda, Daniel
AU - Stefanini, Matteo
AU - Fabiano, Sebastiano
AU - Pampana, Enrico
AU - Stanzione, Paolo
AU - Gandini, Roberto
PY - 2017/4/1
Y1 - 2017/4/1
N2 - Purpose To evaluate outcomes and prognostic factors in patients with acute ischemic stroke caused by tandem internal carotid artery/middle cerebral artery occlusion undergoing endovascular treatment. Materials and Methods Characteristics of consecutive patients with tandem occlusion (TO) were extracted from a prospective registry. Collateral vessel quality on pretreatment computed tomographic (CT) angiography was evaluated on a 4-point grading scale, and patients were dichotomized as having poor or good collateral flow. Outcome measures included successful reperfusion according to Thrombolysis In Cerebral Infarction score, good outcome at 3 months defined as a modified Rankin scale score ≤ 2, symptomatic intracranial hemorrhage (ICH; sICH), and mortality. Results A total of 72 patients with TO (mean age, 65.6 y ± 12.8) were treated. Intravenous thrombolysis was performed in 54.1% of patients, and a carotid stent was inserted in 48.6%. Successful reperfusion was achieved in 64% of patients, and a good outcome was achieved in 32%. sICH occurred in 12.5% of patients, and the overall mortality rate was 32%. Univariate analysis demonstrated that good outcome was associated with good collateral flow (P = .0001), successful reperfusion (P = .001), and lower rate of any ICH (P = .02) and sICH (P = .04). On multivariate analysis, good collateral flow (odds ratio [OR], 0.18; 95% confidence interval [CI], 0.04–0.75; P = .01) and age (OR, 1.08; 95% CI, 1.01–1.15; P = .01) were the only predictors of good outcome. The use of more than one device for thrombectomy was the only predictor of sICH (OR, 10.74; 95% CI, 1.37–84.13; P = .02). Conclusions Endovascular treatment for TO resulted in good outcomes. Collateral flow and age were independent predictors of good clinical outcomes at 3 months.
AB - Purpose To evaluate outcomes and prognostic factors in patients with acute ischemic stroke caused by tandem internal carotid artery/middle cerebral artery occlusion undergoing endovascular treatment. Materials and Methods Characteristics of consecutive patients with tandem occlusion (TO) were extracted from a prospective registry. Collateral vessel quality on pretreatment computed tomographic (CT) angiography was evaluated on a 4-point grading scale, and patients were dichotomized as having poor or good collateral flow. Outcome measures included successful reperfusion according to Thrombolysis In Cerebral Infarction score, good outcome at 3 months defined as a modified Rankin scale score ≤ 2, symptomatic intracranial hemorrhage (ICH; sICH), and mortality. Results A total of 72 patients with TO (mean age, 65.6 y ± 12.8) were treated. Intravenous thrombolysis was performed in 54.1% of patients, and a carotid stent was inserted in 48.6%. Successful reperfusion was achieved in 64% of patients, and a good outcome was achieved in 32%. sICH occurred in 12.5% of patients, and the overall mortality rate was 32%. Univariate analysis demonstrated that good outcome was associated with good collateral flow (P = .0001), successful reperfusion (P = .001), and lower rate of any ICH (P = .02) and sICH (P = .04). On multivariate analysis, good collateral flow (odds ratio [OR], 0.18; 95% confidence interval [CI], 0.04–0.75; P = .01) and age (OR, 1.08; 95% CI, 1.01–1.15; P = .01) were the only predictors of good outcome. The use of more than one device for thrombectomy was the only predictor of sICH (OR, 10.74; 95% CI, 1.37–84.13; P = .02). Conclusions Endovascular treatment for TO resulted in good outcomes. Collateral flow and age were independent predictors of good clinical outcomes at 3 months.
UR - http://www.scopus.com/inward/record.url?scp=85014090757&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85014090757&partnerID=8YFLogxK
U2 - 10.1016/j.jvir.2017.01.007
DO - 10.1016/j.jvir.2017.01.007
M3 - Article
C2 - 28258802
AN - SCOPUS:85014090757
VL - 28
SP - 543
EP - 549
JO - Journal of Vascular and Interventional Radiology
JF - Journal of Vascular and Interventional Radiology
SN - 1051-0443
IS - 4
ER -