E-067 management of tandem intracranial and extracranial occlusion causing hyper acute ischemic stroke with extracranial cervical stenting in conjunction with mechanical thrombectomy

Abstract

Objectives To assess the clinical outcome of major stroke secondary to tandem occlusions using extra-cranial internal carotid or vertebral artery stenting and mechanical thrombectomy (MT). Methods In a retrospective analysis of our Stroke Thrombectomy database (n = 166), we identified 21 patients who underwent extra-cranial ICA or Vertebral artery (VA) stenting in conjunction with MT. 18 patients underwent extra-cranial ICA stenting for tandem ICA/MCA (TIM) occlusions and 3 patients had vertebral origin stenting for VA origin/basilar artery occlusions. We examined neurological improvement defined by ≥ 8 point reduction of National Institutes of Health Stroke Scale (NIHSS) score at 7 days and an improved modified Rankin Scale (mRS ≤ 2) score at 90 days. Successful recanalization based on thrombolysis in cerebral infarction (TICI) score of 2b or 3 was also evaluated. Results 47.6% (n = 10) had a reduction in the NIHSS score by ≥ 8 points. 52.3% (11 patients) had a good outcome with a mRS ≤ 2. 90.4% (n = 19) achieved TICI 2b/3 signifying successful recanalization. Mortality was 19% (n = 4) with 3 deaths due to malignant MCA and 1 death due to pneumonia. No symptomatic intracranial hemorrhage was noted. Conclusions Major Strokes due to TIM and VA origin/basilar occlusions can be successfully treated by extra-cranial internal carotid artery or vertebral artery stenting and mechanical thrombectomy (MT). Advances in knowledge We favor the use of a hybrid approach in terms of the proximal-distal sequence as it achieves early cerebral recanalization and also reduces the procedure time. This is one of the largest studies at present in the United Kingdom. Disclosures S. Nayak: None. V. Leung: None. T. Woo: None. A. Sastry: None.