Fernández Menéndez Santiago, Murias Quintana Eduardo, Vega Valdés Pedro, Morales Deza Edison, López-Cancio Elena, Benavente Fernández Lorena, González Delgado Montserrat, Rico-Santos Maria, Calleja Puerta Sergio, Larrosa Campo Davinia
Service of Neurology, University Hospital "Central de Asturias" and ISPA, Oviedo, Spain.
Service of Radiology, University Hospital "Central de Asturias" and ISPA, Oviedo, Spain.
Cerebrovasc Dis Extra. 2020;10(2):50-58. doi: 10.1159/000507919. Epub 2020 Jun 24.
Acute ischemic strokes with tandem occlusions, which represent 10-20% of all ischemic strokes, have a particularly poor prognosis. Since emergent treatment of tandem lesions has not been specifically addressed in randomized trials, there is an absence of standardized management.
We sought to assess the efficacy and safety of acute endovascular treatment in stroke due to tandem occlusions in our center and compare the results with previous reports.
From a prospective registry we analyzed data of 99 consecutive patients (males: 77.7%, mean age ± SD: 67.5 ± 9.5 years) with stroke due to tandem occlusions who underwent treatment with emergent carotid stenting and intracranial mechanical thrombectomy. Successful recanalization was defined as a TICI score of 2b-3 and a good functional outcome was defined as a modified Rankin scale score ≤2 at 90 days. Symptomatic intracranial hemorrhage (sICH) was considered when associated with worsening on the National Institutes of Health Stroke Scale (≥4 points).
A successful recanalization rate was achieved in 87.8 and 48.5% of the patients had a good functional outcome. sICH and mortality rates were 12.1 and 20.2%, respectively, and 21.2% of the patients received combined treatment with intravenous thrombolysis, which did not affect neither the prognosis nor the recanalization or sICH rates. The time from symptom onset to recanalization and the degree of recanalization were the main factors associated with prognosis and the occurrence of sICH.
Our results suggest that endovascular treatment with emergent carotid stenting and intracranial thrombectomy in patients with acute stroke due to tandem occlusions is an effective and safe procedure.
串联闭塞性急性缺血性卒中占所有缺血性卒中的10%-20%，预后特别差。由于随机试验中尚未专门涉及串联病变的紧急治疗，因此缺乏标准化管理。
我们试图评估在我们中心对串联闭塞性卒中进行急性血管内治疗的有效性和安全性，并将结果与先前的报告进行比较。
从一个前瞻性登记处，我们分析了99例连续的串联闭塞性卒中患者（男性占77.7%，平均年龄±标准差：67.5±9.5岁）的数据，这些患者接受了紧急颈动脉支架置入术和颅内机械取栓治疗。成功再通定义为脑梗死溶栓分级（TICI）评分2b-3级，良好功能结局定义为90天时改良Rankin量表评分≤2分。当与美国国立卫生研究院卒中量表评分恶化（≥4分）相关时，考虑为症状性颅内出血（sICH）。
87.8%的患者实现了成功再通，48.5%的患者有良好的功能结局。sICH和死亡率分别为12.1%和20.2%，21.2%的患者接受了静脉溶栓联合治疗，这对预后、再通率或sICH发生率均无影响。从症状发作到再通的时间以及再通程度是与预后和sICH发生相关的主要因素。
我们的结果表明，对串联闭塞性急性卒中患者进行紧急颈动脉支架置入术和颅内取栓的血管内治疗是一种有效且安全的方法。
