title: Endovascular Management of Acute Ischemic Strokes with Tandem Occlusions.
abstract: Ischemic strokes with tandem occlusions are associated with a poor prognosis. Recent studies demonstrating the effectiveness of endovascular treatment for large vessel occlusions have shown less impressive results in patients with tandem occlusions than in those with isolated intracranial occlusions. Also, the indications and effects of carotid stenting remain unclear.
  
  
  
  From a prospectively gathered registry, we analyzed data of 70 consecutive patients who underwent mechanical endovascular treatment for acute stroke with tandem occlusions from November 2011 to August 2014. Clinical (including demographics, National Institutes of Health Stroke Scale (NIHSS), and stroke etiology), imaging (including diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score), and endovascular treatment data were assessed and reviewed in consensus by 2 observers. Good clinical outcome was defined as a modified Rankin Scale of ≤2 at 3-month follow-up.
  
  
  
  At 3-month follow-up, 50.8% had a poor clinical outcome, including death in 13.4%. Lower NIHSS (initial, at day 1, and at discharge) and successful recanalization (thrombolysis in cerebral infarction 2b-3) were associated with a good clinical outcome (p < 0.05). There were no statistically significant differences between patients with a good or poor clinical outcome in terms of intravenous (IV) tissue plasminogen activator use, delay between symptom onset and recanalization, and endovascular technique including the carotid stenting.
  
  
  
  Despite the recent randomized control trials demonstrating the effectiveness of thrombectomy, there is still a research gap about tandem occlusions. This subtype of stroke, which usually responds poorly to IV thrombolysis, is also difficult to treat by endovascular means. Guidelines for the endovascular management of tandem occlusions are needed.
authors: Department of Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
authors: Robert
authors: R
authors: Fahed
authors: Hocine
authors: H
authors: Redjem
authors: Raphaël
authors: R
authors: Blanc
authors: Julien
authors: J
authors: Labreuche
authors: Thomas
authors: T
authors: Robert
authors: Gabriele
authors: G
authors: Ciccio
authors: Didier
authors: D
authors: Smadja
authors: Stanislas
authors: S
authors: Smajda
authors: Michel
authors: M
authors: Piotin
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010297:Paris; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D017131:Thrombectomy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome