Emergent Management of Tandem Occlusions in Anterior Circulation Stroke: A Single-Centre Experience

Abstract

For anterior circulation tandem occlusions (TOs)， the optimal management strategy for extracranial carotid lesions is controversial. We aimed to compare the efficacy and safety of acute stenting (AS) with balloon angioplasty only (BA). Clinical data were collected from 98 patients with anterior circulation TO who underwent endovascular treatment at our center. Of these patients, 64 and 34 were assigned to the AS and BA groups, respectively. The clinical characteristics and outcome data of the two groups were analyzed and compared. The proportion of patients with good outcomes was 59.2%. The AS group had a higher rate of successful recanalization (98.4% vs. 82.4%, P = 0.007) and a lower rate of occlusion of the responsible vessel at 90 days (14.1% vs. 32.4%, P = 0.039) than the BA group. The AS group was also significantly better than the BA group in terms of good outcomes (67.2% vs. 44.1%, P = 0.027), but there was no significant difference between the two groups in terms of 90-day mortality (6.3% vs. 8.8%, P = 0.691) and asymptomatic intracranial hemorrhage (aICH) (6.3% vs. 5.9%, P = 1.000). Lower baseline National Institutes of Health Stroke Scale (NIHSS)scores were associated with good outcomes (P < 0.001) and the presence of sICH was associated with 90-day mortality (P = 0.003). Acute stent placement in patients with acute ischaemic stroke due to anterior circulation TO may have a better outcome than BA alone, and the safety of both approaches is comparable.