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Neuroradiology

, Volume 57, Issue 6, pp 589–598 | Cite as

Mechanical thrombectomy in tandem occlusion: procedural considerations and clinical results

  • H. Lockau
  • T. Liebig
  • T. Henning
  • V. Neuschmelting
  • H. Stetefeld
  • C. Kabbasch
  • F. DornEmail author
Interventional Neuroradiology

Abstract

Introduction

Acute tandem occlusions of the cervical and distal internal carotid artery (ICA) or middle cerebral artery (MCA) are associated with major stroke with intravenous (i.v.) thrombolysis alone in approximately 90 % of patients. The data on endovascular management of tandem occlusions is still limited. The purpose of this study was to review technical aspects and the current state of the literature on acute ICA stenting in combination with stent retriever-based intracranial thrombectomy.

Methods

We retrospectively reviewed the data of 37 consecutive patients with tandem occlusions including clinical parameters, angiographic results, procedural aspects, complications, and hemorrhages.

Results

Median National Institutes of Health Stroke Scale (NIHSS) on admission was 17 (3–30). Intracranial thrombectomy was performed prior to ICA stenting in 25/37 (67.6 %) and after stenting in 12/37 (32.4 %) patients. ICA stenting was successful in all cases, and a thrombolysis in cerebral infarction (TICI) scale 2b/3 result was achieved in 27/37 (73 %) cases. The mean angiography time was significantly shorter in the “thrombectomy first” group (43.1 ± 30.8 vs. 110.8 ± 43.0 min, p < 0.001), and more patients had favorable outcomes after 3 months (13/25 = 52.0 vs. 4/12 = 33.3 %, p = 0.319). In this group, intermediate catheters were used and successfully prevented embolism to unaffected territories in all cases.

Conclusion

Acute stenting of the cervical ICA in combination with intracranial thrombectomy was technically feasible and safe in our series. Thrombectomy prior to proximal stenting was associated with shorter reperfusion times and a tendency towards better clinical outcome leading to a good outcome in about 50 % of the patients. Therefore, we recommend this approach in tandem occlusion requiring stent angioplasty.

Keywords

Tandem occlusions Stent retriever Endovascular Stroke Stent 

Notes

Ethical standards and patient consent

We declare that all human and animal studies have been approved by the local Ethics Committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.

Conflict of interest

TL consults for Concentric, now part of Stryker.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • H. Lockau
    • 1
  • T. Liebig
    • 1
  • T. Henning
    • 1
  • V. Neuschmelting
    • 2
  • H. Stetefeld
    • 3
  • C. Kabbasch
    • 1
  • F. Dorn
    • 1
    Email author
  1. 1.Department of RadiologyUniversity Hospital of CologneCologneGermany
  2. 2.Department of NeurosurgeryUniversity Hospital of CologneCologneGermany
  3. 3.Department of NeurologyUniversity Hospital of CologneCologneGermany

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