title: Endovascular procedures versus intravenous thrombolysis in stroke with tandem occlusion of the anterior circulation.
abstract: OBJECTIVE
  Stroke with tandem occlusion within the anterior circulation presents a lower probability of recanalization and good clinical outcome after intravenous (IV) thrombolysis than stroke with single occlusion. The present study describes the impact of endovascular procedures (EPs) compared with IV thrombolysis alone on recanalization and clinical outcome.
  
  
  METHODS
  Thirty patients with symptom onset less than 4.5 hours and tandem occlusion within the anterior circulation were analyzed retrospectively. Recanalization was assessed per Thrombolysis In Cerebral Infarction (TICI) classification on computed tomography, magnetic resonance imaging, or digital subtraction angiography within 24 hours. Infarct size was detected on follow-up imaging as a dichotomized variable, ie, more than one third of the territory of the middle cerebral artery. Clinical outcomes were major neurologic improvement, independent outcome (90-d modified Rankin Scale [mRS] score), symptomatic intracerebral hemorrhage (sICH; per European Cooperative Acute Stroke Study criteria), and death within 7 days.
  
  
  RESULTS
  Patients treated with EPs (n = 14) were significantly younger and had a history of arterial hypertension more frequently than patients treated with IV thrombolysis alone (n = 16). Recanalization (ie, TICI score 2b/3; EP, 64%; IV, 19%; P = .01), major neurologic improvement (EP, 64%; IV, 19%; P = .01), and independent outcome (mRS score ≤ 2; EP, 54% IV, 13%; P = .02) occurred more often in the EP group, whereas infarct sizes greater than one third of the MCA territory (EP, 43%; IV, 81%; P = .03) were observed less often. Rates of sICH (P = .12) and death within 7 days (P = .74) did not differ significantly.
  
  
  CONCLUSIONS
  Higher recanalization rate, smaller infarct volume, and better clinical outcome in the EP group should encourage researchers to include this subgroup of patients in prospective randomized trials comparing IV thrombolysis versus EP in stroke.
authors.affiliation: Department of Neurology, Charité-Universitätsmedizin, Berlin, Germany. Electronic address: serdar.tuetuencue@charite.de.
authors.forename: Serdar
authors.initials: S
authors.lastname: Tütüncü
authors.affiliation: Department of Neurology, Charité-Universitätsmedizin, Berlin, Germany; Center of Stroke Research, Berlin, Germany.
authors.forename: Jan F
authors.initials: JF
authors.lastname: Scheitz
authors.affiliation: Department of Radiology, Charité-Universitätsmedizin, Berlin, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Bohner
authors.affiliation: Center of Stroke Research, Berlin, Germany.
authors.forename: Jochen B
authors.initials: JB
authors.lastname: Fiebach
authors.affiliation: Department of Neurology, Charité-Universitätsmedizin, Berlin, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Endres
authors.affiliation: Department of Neurology, Charité-Universitätsmedizin, Berlin, Germany; Center of Stroke Research, Berlin, Germany.
authors.forename: Christian H
authors.initials: CH
authors.lastname: Nolte
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography / Q000379:methods; D004185:Disability Evaluation; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D020243:Infarction, Anterior Cerebral Artery / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D007262:Infusions, Intravenous; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents