Yang Dong, Shi Zhonghua, Lin Min, Zhou Zhiming, Zi Wenjie, Wang Huaiming, Hao Yonggang, Guo Fuqiang, Liu Wenhua, Xu Gelin, Xiong Yunyun, Liu Xinfeng
1 Department of Neurology, Jinling Hospital, Nanjing, China.
2 Department of Neurosurgery, The 101st Hospital of The People's Liberation Army, Wuxi, China.
Interv Neuroradiol. 2019 Apr;25(2):194-201. doi: 10.1177/1591019918805140. Epub 2018 Oct 5.
The endovascular treatment strategy for acute tandem occlusion stroke is challenging, and controversy exists regarding which lesion should be treated first. This study addresses the uncertainty regarding the priority choice for thrombectomy in acute anterior circulation tandem occlusion stroke.
We analysed the clinical and angiographic data of tandem stroke patients who underwent interventional therapy from the endovAsCular Treatment of acUte Anterior circuLation ischaemic stroke (ACTUAL) registry. Recanalisation was assessed according to the modified thrombolysis in cerebral infarction score. Clinical outcome was evaluated at 90 days using the modified Rankin scale score.
Sixty tandem occlusion stroke patients were enrolled. Thirty-one (51.7%) patients received anterograde therapy, while 29 (48.3%) patients underwent the retrograde approach. Successful recanalisation (modified thrombolysis in cerebral infarction score 2b-3) occurred in 78.3% (47/60) of patients, and 50.0% (30/60) of patients achieved a modified Rankin scale score of 0-2 at 90 days. Patients undergoing the retrograde approach spent less time in distal occlusion recanalisation (125 (86-167) vs. 95 (74-122) minutes; P = 0.04) and achieved better functional outcomes at 90 days (69.0% (20/29) vs. 32.3% (10/31); P = 0.004) than patients who received anterograde therapy. The retrograde approach was associated with favourable clinical outcomes (odds ratio 0.21; 95% confidence interval 0.07-0.64; P = 0.006).
For acute tandem occlusion stroke, favourable outcomes were better in patients undergoing retrograde therapy than in patients who received the anterograde approach. Future randomised trials are warranted to determine the optimal treatment.
急性串联闭塞性卒中的血管内治疗策略具有挑战性，对于应先治疗哪个病变存在争议。本研究旨在解决急性前循环串联闭塞性卒中血栓切除术优先选择的不确定性。
我们分析了来自急性前循环缺血性卒中血管内治疗（ACTUAL）注册研究中接受介入治疗的串联性卒中患者的临床和血管造影数据。根据改良的脑梗死溶栓评分评估再通情况。使用改良Rankin量表评分在90天时评估临床结局。
纳入60例串联闭塞性卒中患者。31例（51.7%）患者接受顺行治疗，而29例（48.3%）患者采用逆行治疗。78.3%（47/60）的患者实现了成功再通（改良脑梗死溶栓评分为2b - 3），50.0%（30/60）的患者在90天时改良Rankin量表评分为0 - 2。采用逆行治疗的患者在远端闭塞再通方面花费的时间更少（125（86 - 167）分钟对95（74 - 122）分钟；P = 0.04），并且在90天时比接受顺行治疗的患者获得了更好的功能结局（69.0%（20/29）对32.3%（10/31）；P = 0.004）。逆行治疗与良好的临床结局相关（比值比0.21；95%置信区间0.07 - 0.64；P = 0.006）。
对于急性串联闭塞性卒中，接受逆行治疗的患者比接受顺行治疗的患者有更好的预后。未来有必要进行随机试验以确定最佳治疗方案。
