Mechanical Thrombectomy in Acute Ischemic Stroke with Tandem Occlusions: Impact of Extracranial Carotid Lesion Etiology on Endovascular Management and Outcome

Valerio Da Ros, Jacopo Scaggiante, Francesca Pitocchi, Fabrizio Sallustio, Simona Lattanzi, Giuseppe Emmanuele Umana, Bipin Chaurasia, Monica Bandettini di Poggio, Gianpaolo Toscano, Claudia Rolla Bigliani, Maria Ruggiero, Nicolò Haznedari, Alessandro Sgreccia, Giuseppina Sanfilippo, Marina Diomedi, Cinzia Finocchi, Roberto Floris

Research output: Contribution to journalArticlepeer-review


Objective Different etiologies of extracranial internal carotid artery steno-occlusive lesions (ECLs) in patients with acute ischemic stroke (AIS) and tandem occlusion (TO) have been pooled together in randomized trials. However, carotid atherosclerosis (CA) and carotid dissection (CD), the two most common ECL etiologies, are distinct nosological entities. The authors aimed to determine if ECL etiology has impacts on the endovascular management and outcome of patients with TO. METHODS A multicenter, retrospective study of prospectively collected data was conducted. AIS patients were included who had TO due to internal CA or CD and ipsilateral M1 middle cerebral artery occlusion and underwent endovascular treatment (EVT). Comparative analyses including demographic data, safety, successful recanalization rates, and clinical outcome were performed according to EVT and ECL etiology. Results In total, 214 AIS patients with TOs were included (77.6% CA related, 22.4% CD related). Patients treated with a retrograde approach were more often functionally independent at 3 months than patients treated with an antegrade approach (OR 0.6, 95% CI 0.4–0.9). Patients with CD-related TOs achieved 90-day clinical independence more often than patients with CA-related TOs (OR 1.4, 95% CI 1.1–2.0). Emergency stenting use was associated with good 3-month clinical outcome only in patients with CA-related TOs (OR 1.4, 95% CI 1.1–2.1). Symptomatic intracranial hemorrhage (sICH) occurred in 10.7% of patients, without differences associated with ECL etiology. Conclusions ECL etiology impacts both EVT approach and clinical outcome in patients with TOs. Patients with CD-related TO achieved higher 3-month functional independence rates than patients with CA-related TOs. A retrograde approach can be desirable for both CA- and CD-related TOs, and emergency stenting is likely better justified in CArelated TOs.

Original languageEnglish
Pages (from-to)1-7
Number of pages7
JournalNeurosurgical Focus
Issue number1
Publication statusPublished - Jul 2021


  • acute ischemic stroke
  • carotid atherosclerosis
  • carotid dissection
  • endovascular acute stroke intervention
  • tandem occlusions
  • thrombectomy
  • thrombolysis

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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