Romano Daniele Giuseppe, Tortora Raffaele, De Simone Matteo, Frauenfelder Giulia, Siani Alfredo, Amoroso Ettore, Locatelli Gianpiero, Taglialatela Francesco, Flora Gianmarco, Diana Francesco, Saponiero Renato
Unit of Interventional Neuroradiology, University Hospital Salerno, Via San Leonardo, 1, 84131 Salerno, Italy.
Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Via S. Allende, 84081 Baronissi, Italy.
J Clin Med. 2025 Apr 24;14(9):2945. doi: 10.3390/jcm14092945.
: Tandem Lesions (TLs) or Tandem Occlusions (TOs) are characterized by simultaneous high-grade stenosis or occlusion of the proximal extracranial internal carotid artery and the intracranial terminal internal carotid artery or its branches. These lesions can result in stroke and pose significant challenges to endovascular treatment. This study introduces and evaluates the "T-Top technique" as an innovative approach to address TLs, assessing its safety and technical efficacy. : Data from acute ischemic stroke (AIS) patients treated with the T-Top technique between September 2022 and September 2023 were retrospectively analyzed. The technique involves using the pusher wire of a stent retriever as a microwire to guide a monorail angioplastic balloon to the extracranial carotid stenosis, performing angioplasty simultaneously with stent retriever anchorage. Clinical outcomes, procedural data, and safety were assessed. : Successful reperfusion (mTICI > 2b) was achieved in 91% of cases, with a median groin puncture to final recanalization time of 50 min. Favorable clinical outcomes (mRS < 3) were observed in 69% of patients, with a low mortality rate of 6% after 90 days. : The T-Top technique offers a rapid and reliable strategy for TL treatment, improving reperfusion rates and clinical outcomes. Further studies are warranted to validate its efficacy in larger cohorts. This technique holds promise for enhancing endovascular treatment outcomes in patients with Tandem Lesions.
串联病变（TLs）或串联闭塞（TOs）的特征是颅外段颈内动脉近端与颅内段颈内动脉终末段或其分支同时出现高度狭窄或闭塞。这些病变可导致中风，给血管内治疗带来重大挑战。本研究介绍并评估了“T-Top技术”这一治疗串联病变的创新方法，评估其安全性和技术疗效。
回顾性分析了2022年9月至2023年9月间采用T-Top技术治疗的急性缺血性卒中（AIS）患者的数据。该技术是将取栓支架的推送导丝用作微导丝，引导单轨血管成形球囊至颅外颈动脉狭窄处，在取栓支架锚定的同时进行血管成形术。评估了临床结局、手术数据和安全性。
91%的病例实现了成功再灌注（改良脑梗死溶栓分级>2b级），从腹股沟穿刺到最终再通的中位时间为50分钟。69%的患者观察到良好的临床结局（改良Rankin量表评分<3分），90天后死亡率低至6%。
T-Top技术为串联病变的治疗提供了一种快速可靠的策略，提高了再灌注率和临床结局。有必要进行进一步研究以在更大队列中验证其疗效。该技术有望改善串联病变患者的血管内治疗结局。
