title: Endovascular Stroke Treatment of Acute Tandem Occlusion: A Single-Center Experience.
abstract: OBJECTIVE
  To evaluate outcomes and prognostic factors in patients with acute ischemic stroke caused by tandem internal carotid artery/middle cerebral artery occlusion undergoing endovascular treatment.
  
  
  METHODS
  Characteristics of consecutive patients with tandem occlusion (TO) were extracted from a prospective registry. Collateral vessel quality on pretreatment computed tomographic (CT) angiography was evaluated on a 4-point grading scale, and patients were dichotomized as having poor or good collateral flow. Outcome measures included successful reperfusion according to Thrombolysis In Cerebral Infarction score, good outcome at 3 months defined as a modified Rankin scale score ≤ 2, symptomatic intracranial hemorrhage (ICH; sICH), and mortality.
  
  
  RESULTS
  A total of 72 patients with TO (mean age, 65.6 y ± 12.8) were treated. Intravenous thrombolysis was performed in 54.1% of patients, and a carotid stent was inserted in 48.6%. Successful reperfusion was achieved in 64% of patients, and a good outcome was achieved in 32%. sICH occurred in 12.5% of patients, and the overall mortality rate was 32%. Univariate analysis demonstrated that good outcome was associated with good collateral flow (P = .0001), successful reperfusion (P = .001), and lower rate of any ICH (P = .02) and sICH (P = .04). On multivariate analysis, good collateral flow (odds ratio [OR], 0.18; 95% confidence interval [CI], 0.04-0.75; P = .01) and age (OR, 1.08; 95% CI, 1.01-1.15; P = .01) were the only predictors of good outcome. The use of more than one device for thrombectomy was the only predictor of sICH (OR, 10.74; 95% CI, 1.37-84.13; P = .02).
  
  
  CONCLUSIONS
  Endovascular treatment for TO resulted in good outcomes. Collateral flow and age were independent predictors of good clinical outcomes at 3 months.
authors.affiliation: Comprehensive Stroke Center and Department of Neuroscience, University of Tor Vergata, Rome, Italy; Neurorehabilitation Unit, Santa Lucia Foundation, Rome, Italy. Electronic address: fsall75@gmail.com.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Sallustio
authors.affiliation: Comprehensive Stroke Center and Department of Neuroscience, University of Tor Vergata, Rome, Italy; Neurorehabilitation Unit, Santa Lucia Foundation, Rome, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Motta
authors.affiliation: Comprehensive Stroke Center and Department of Neuroscience, University of Tor Vergata, Rome, Italy; Neurorehabilitation Unit, Santa Lucia Foundation, Rome, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Koch
authors.affiliation: Comprehensive Stroke Center and Department of Neuroscience, University of Tor Vergata, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Pizzuto
authors.affiliation: Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.
authors.forename: Bruce C V
authors.initials: BC
authors.lastname: Campbell
authors.affiliation: Comprehensive Stroke Center and Department of Neuroscience, University of Tor Vergata, Rome, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Diomedi
authors.affiliation: Comprehensive Stroke Center and Department of Neuroscience, University of Tor Vergata, Rome, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Rizzato
authors.affiliation: Comprehensive Stroke Center and Department of Neuroscience, University of Tor Vergata, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Davoli
authors.affiliation: Department of Interventional Radiology and Neuroradiology, University of Tor Vergata, Rome, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Loreni
authors.affiliation: Department of Interventional Radiology and Neuroradiology, University of Tor Vergata, Rome, Italy.
authors.forename: Daniel
authors.initials: D
authors.lastname: Konda
authors.affiliation: Department of Interventional Radiology and Neuroradiology, University of Tor Vergata, Rome, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Stefanini
authors.affiliation: Department of Interventional Radiology and Neuroradiology, University of Tor Vergata, Rome, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Fabiano
authors.affiliation: Department of Interventional Radiology and Neuroradiology, University of Tor Vergata, Rome, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Pampana
authors.affiliation: Comprehensive Stroke Center and Department of Neuroscience, University of Tor Vergata, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Stanzione
authors.affiliation: Comprehensive Stroke Center and Department of Neuroscience, University of Tor Vergata, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Gandini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D002560:Cerebrovascular Circulation; D003097:Collateral Circulation; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D020300:Intracranial Hemorrhages / Q000209:etiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D020127:Recovery of Function; D012039:Regional Blood Flow; D012042:Registries; D012307:Risk Factors; D012384:Rome; D015607:Stents; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome