title: Endovascular treatment of tandem occlusions of the anterior cerebral circulation with solitaire FR thrombectomy system. Initial experience.
abstract: OBJECTIVE
  The optimal treatment in the acute phase of cervical internal carotid occlusion associated with intracranial obstruction is a matter of debate. In this study, we report our experience using the Solitaire FR revascularization device and synchronous intravenous fibrinolysis. The distal occlusion was treated with Solitaire FR before the proximal one in all cases, a technique not reported so far in the literature.
  
  
  METHODS
  We examined all cases of tandem occlusion treated in our institution between November 2009 and November 2010. The proximal occlusion was treated using manual thromboaspiration in order to achieve intracranial recanalization as rapid as possible. When necessary, stenting was performed after the reconstitution of the intracranial vessel. Morphological and clinical results were recorded in the immediate post-operative phase and at the three-month follow-up. Clinical success was defined as a mRS at 3 months≤2.
  
  
  RESULTS
  Four male and six female patients were treated (mean age 66 years). The cervical carotid was recanalized in all cases and the intracranial vessel (TICI≥2b) in eight. Adverse events were recorded in four patients of which three were asymptomatic. These included two cases of subarachnoid hemorrhage, one case of traumatic dissection, and one case of fatal intra-cerebral hemorrhage seven days following the procedure. At the three-month follow-up a mRS≤2 was observed in four patients.
  
  
  CONCLUSIONS
  The described approach for the treatment of tandem occlusions is promising with regard to both morphological and clinical assessments and thus may be considered a valid tool in acute stroke.
authors.affiliation: Montpellier University Hospital, Department of Neuroradiology, Montpellier, France. paolo.machi@gmail.com
authors.forename: Paolo
authors.initials: P
authors.lastname: Machi
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Lobotesis
authors.forename: Igor Lima
authors.initials: IL
authors.lastname: Maldonado
authors.forename: Vincent
authors.initials: V
authors.lastname: Costalat
authors.forename: Jean Francois
authors.initials: JF
authors.lastname: Vendrell
authors.forename: Carlos
authors.initials: C
authors.lastname: Riquelme
authors.forename: Alain
authors.initials: A
authors.lastname: Bonafé
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D057510:Endovascular Procedures / Q000295:instrumentation*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011859:Radiography; D017131:Thrombectomy / Q000295:instrumentation*; D016896:Treatment Outcome