Faculty, Staff and Student Publications

Language

English

Publication Date

7-1-2025

Journal

STROKE: Vascular and Interventional Neurology

DOI

10.1161/SVIN.124.001598

PMID

41573705

PMCID

PMC12697657

PubMedCentral® Posted Date

6-23-2025

PubMedCentral® Full Text Version

Post-print

Abstract

Background: Tandem lesions pose unique challenges in the endovascular treatment of acute ischemic stroke. We aimed to compare the clinical and procedural outcomes of patients with tandem lesions and extracranial internal carotid artery (ICA) complete occlusion versus those with moderate to severe stenosis.

Methods: This is a subanalysis of a multicenter cohort of patients with acute anterior circulation tandem lesions treated with intracranial mechanical thrombectomy and carotid artery stenting, between January 2015 and December 2020. The patients were categorized into 2 groups: extracranial ICA stenosis >70% to 99% and complete occlusion. Outcomes included successful and excellent recanalization, functional independence, symptomatic intracranial hemorrhage, and puncture-to-recanalization time. Sensitivity analyses were conducted based on varying degrees of stenosis, and we explored interactions with age, Alberta Stroke Program Early CT [Computed Tomography] Score, National Institutes of Health Stroke Scale, procedural antiplatelets, ICA treatment approach, ICA lesion etiology, Intravenous thrombolysis, and use of a balloon-guide catheter.

Results: The study included 323 patients; 166 (51.4%) of whom presented with ICA occlusion and 157 (48.6%) with severe stenosis. Patients with ICA occlusion had significantly higher rates of previous stroke/transient ischemic attack, and antegrade ICA treatment approach. The comparison between both groups in univariable and multivariable analysis revealed no significant differences in the rates of successful and excellent recanalization, functional independence, symptomatic intracranial hemorrhage, and additional outcomes. The median puncture-to-recanalization time was longer in the occlusion group (adjusted coefficient, 1.21 [95% CI 1.01-1.46], P = 0.05). When categorized into 3 groups (occlusion, severe, and moderate stenosis), median puncture-to-recanalization time was significantly higher in patients with occlusion (adjusted coefficient, 1.34 [95% CI, 1.04-1.71], P = 0.022), and a trend toward statistical significance was observed in patients with severe stenosis (adjusted coefficient, 1.29 [95% CI, 0.98-1.71], P = 0.068), compared with patients with moderate stenosis. Interaction analysis did not yield significant differences.

Conclusion: In patients with tandem lesions, those with ICA occlusion presented longer puncture-to-recanalization time than patients with cervical stenosis. This observation might be linked to higher rates of an antegrade approach in patients with ICA occlusion.

Keywords

carotid artery stenting, carotid occlusion, carotid stenosis, ischemic stroke, mechanical thrombectomy

Published Open-Access

yes

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