title: Stent-Retriever Thrombectomy for Acute Anterior Ischemic Stroke with Tandem Occlusion: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  To assess the efficacy and safety profile of stent-retriever thrombectomy (SRT) in acute anterior ischemic stroke patients with tandem occlusion.
  
  
  METHODS
  Using the MEDLINE database, we conducted a systematic review and meta-analysis of all studies that included patients with acute ischemic stroke attributable to tandem occlusion who received treatment with SRT between November 2010 and May 2015.
  
  
  RESULTS
  The literature search identified 11 previous studies involving a total of 237 subjects out of whom 193 (81.4 %) were treated with acute stent placement for the extracranial internal carotid artery occlusion. Mean initial NIHSS score was 17, and median time from onset to recanalization was 283.5 min. Mean intravenous thrombolysis rate was 63.8 %. In the meta-analysis, the recanalization rate reached 81 % (95 % CI, 73-89). Meta-analysis of clinical outcomes showed a pooled estimate of 44 % (95 % CI, 33-55; 10 studies) for favourable outcome, 13 % (95 % CI, 8-20; 10 studies) for mortality, and 7 % (95 % CI, 2-13; eight studies) for symptomatic intracranial haemorrhage.
  
  
  CONCLUSIONS
  SRT with emergency carotid stenting is associated with acceptable safety and efficacy in acute anterior stroke patients with tandem occlusion compared to natural history. However, the best modality to treat proximal stenosis is based on an individual case basis.
  
  
  CONCLUSIONS
  • Stent retriever thrombectomy of tandem occlusion is efficient and safe. • Emergent carotid stenting during thrombectomy increase symptomatic intracranial haemorrhage without impact mortality. • Thrombectomy of tandem anterior circulation occlusion may be the first therapeutic option.
authors.affiliation: FHU IRIS, Department of Interventional Neuroradiology, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, Bron, France.|Université Claude Bernard lyon 1, Lyon, France.|Department of Interventional Neuroradiology, Western Galilee Hospital, Nahariyya, Israel.
authors.forename: Rotem
authors.initials: R
authors.lastname: Sivan-Hoffmann
authors.affiliation: FHU IRIS, Department of Interventional Neuroradiology, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, Bron, France. benjamin.gory@chu-lyon.fr.|Université Claude Bernard lyon 1, Lyon, France. benjamin.gory@chu-lyon.fr.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Gory
authors.affiliation: Hospices Civils de Lyon, Délégation à la Recherche Clinique et à l'Innovation, Cellule Innovation/UMR-CNRS 5510/MATEIS, Bron, France.|Division of Health Sciences, The University of Warwick, Warwick Medical School, Coventry, England.
authors.forename: Xavier
authors.initials: X
authors.lastname: Armoiry
authors.affiliation: Department of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Mayank
authors.initials: M
authors.lastname: Goyal
authors.affiliation: FHU IRIS, Department of Interventional Neuroradiology, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, Bron, France.
authors.forename: Roberto
authors.initials: R
authors.lastname: Riva
authors.affiliation: FHU IRIS, Department of Interventional Neuroradiology, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, Bron, France.
authors.forename: Paul Emile
authors.initials: PE
authors.lastname: Labeyrie
authors.affiliation: Université Claude Bernard lyon 1, Lyon, France.|Fédération Hospitalo-Universitaire d'Anesthésie Réanimation Neurologique, Hôpital Neurologique Pierre Wertheimer, Bron, France.|EA PI3 Pathophysiology of injury-induced immunosuppression, Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Anne-Claire
authors.initials: AC
authors.lastname: Lukaszewicz
authors.affiliation: Université Claude Bernard lyon 1, Lyon, France.|Fédération Hospitalo-Universitaire d'Anesthésie Réanimation Neurologique, Hôpital Neurologique Pierre Wertheimer, Bron, France.|EA PI3 Pathophysiology of injury-induced immunosuppression, Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Lehot
authors.affiliation: FHU IRIS, Department of Neurology, Stroke Unit, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Bron, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Derex
authors.affiliation: FHU IRIS, Department of Interventional Neuroradiology, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, Bron, France.|Université Claude Bernard lyon 1, Lyon, France.
authors.forename: Francis
authors.initials: F
authors.lastname: Turjman
mesh_terms: D001157:Arterial Occlusive Diseases / Q000150:complications / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000601:surgery; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery; D020878:Device Removal; D006801:Humans; D020768:Middle Cerebral Artery; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000601:surgery*; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome
keywords: Anterior circulation; Large vessel occlusion; Stent retriever; Stroke; Thrombectomy