Di Donna Antonio, Muto Gianluca, Giordano Flavio, Muto Massimo, Guarnieri Gianluigi, Servillo Giovanna, De Mase Antonio, Spina Emanuele, Leone Giuseppe
Unit of Interventional Neuroradiology, Department of Advanced Diagnostic and Therapeutic Technologies, A.O.R.N. Antonio Cardarelli Hospital, Via Cardarelli 1, Naples 80131, Italy.
Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, 1205 Geneva, Switzerland.
Eur J Radiol Open. 2023 Aug 14;11:100513. doi: 10.1016/j.ejro.2023.100513. eCollection 2023 Dec.
Approximately 20-30% of patients with acute ischemic stroke, caused by large intracranial vessel occlusion, have a tandem lesion, defined as simultaneous presence of high-grade stenosis or occlusion of the cervical internal carotid artery and thromboembolic occlusion of the intracranial terminal internal carotid artery or its branches, usually the middle cerebral artery. Patients with tandem lesions have usually worse outcomes than patients with single intracranial occlusions, and intravenous thrombolysis is less effective in these patients. Although endovascular thrombectomy is currently a cornerstone therapy in the management of acute ischemic stroke due to large vessel occlusion, the optimal management of extracranial carotid lesions in tandem occlusion remains controversial. Acute placement of a stent in the cervical carotid artery lesion is the most used therapeutic strategy compared with stented balloon angioplasty and thrombectomy alone without carotid artery revascularization; however, treatment strategies in these patients are often more complex than with single occlusion, so treatment decisions can change based on clinical and technical considerations. The aim of this review is to analyze the results of different studies and trials, investigating the periprocedural neurointerventional management of patients with tandem lesions and the safety, efficacy of the different technical strategies available as well as their impact on the clinical outcome in these patients, to strengthen current recommendations and thus optimize patient care.
由颅内大血管闭塞引起的急性缺血性卒中患者中，约20%-30%存在串联病变，即颈内动脉存在高级别狭窄或闭塞，同时颅内颈内动脉终末段或其分支（通常为大脑中动脉）存在血栓栓塞性闭塞。与单纯颅内闭塞患者相比，串联病变患者的预后通常更差，静脉溶栓对这些患者的效果也较差。尽管血管内血栓切除术目前是治疗大血管闭塞所致急性缺血性卒中的基石疗法，但串联闭塞中颅外颈动脉病变的最佳治疗方案仍存在争议。与单纯球囊血管成形术和血栓切除术且不进行颈动脉血运重建相比，在颈段颈动脉病变处急性置入支架是最常用的治疗策略；然而，这些患者的治疗策略往往比单纯闭塞更为复杂，因此治疗决策可能会根据临床和技术因素而改变。本综述的目的是分析不同研究和试验的结果，探讨串联病变患者围手术期神经介入治疗的管理，以及现有不同技术策略的安全性、有效性及其对这些患者临床结局的影响，以强化当前建议从而优化患者护理。
