European Radiology

, Volume 27, Issue 1, pp 247–254 | Cite as

Stent-Retriever Thrombectomy for Acute Anterior Ischemic Stroke with Tandem Occlusion: A Systematic Review and Meta-Analysis

  • Rotem Sivan-Hoffmann
  • Benjamin Gory
  • Xavier Armoiry
  • Mayank Goyal
  • Roberto Riva
  • Paul Emile Labeyrie
  • Anne-Claire Lukaszewicz
  • Jean-Jacques Lehot
  • Laurent Derex
  • Francis Turjman
Neuro

Abstract

Objectives

To assess the efficacy and safety profile of stent-retriever thrombectomy (SRT) in acute anterior ischemic stroke patients with tandem occlusion.

Materials and 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.

Conclusion

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.

Key Points

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

Keywords

Stent retriever Stroke Thrombectomy Large vessel occlusion Anterior circulation 

Notes

Acknowledgments

The scientific guarantor of this publication is Benjamin Gory, MD, MSc. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Xavier Armoiry kindly provided statistical advice for this manuscript. Institutional Review Board approval was not required because it’s a systematic review. Written informed consent was not required for this study because it’s a systematic review of published articles. Approval from the institutional animal care committee was not required because it’s clinical research. Some study subjects or cohorts have been previously reported in Pubmed database. Methodology: retrospective, observational, multicenter study.

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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Rotem Sivan-Hoffmann
    • 1
    • 2
    • 3
  • Benjamin Gory
    • 1
    • 2
  • Xavier Armoiry
    • 4
    • 9
  • Mayank Goyal
    • 5
  • Roberto Riva
    • 1
  • Paul Emile Labeyrie
    • 1
  • Anne-Claire Lukaszewicz
    • 2
    • 6
    • 7
  • Jean-Jacques Lehot
    • 2
    • 6
    • 7
  • Laurent Derex
    • 8
  • Francis Turjman
    • 1
    • 2
  1. 1.FHU IRIS, Department of Interventional Neuroradiology, Hospices Civils de LyonHôpital Neurologique Pierre WertheimerBronFrance
  2. 2.Université Claude Bernard lyon 1LyonFrance
  3. 3.Department of Interventional NeuroradiologyWestern Galilee HospitalNahariyyaIsrael
  4. 4.Hospices Civils de Lyon, Délégation à la Recherche Clinique et à l’InnovationCellule Innovation/UMR-CNRS 5510/MATEISBronFrance
  5. 5.Department of Radiology and Clinical NeurosciencesUniversity of CalgaryCalgaryCanada
  6. 6.Fédération Hospitalo-Universitaire d’Anesthésie Réanimation NeurologiqueHôpital Neurologique Pierre WertheimerBronFrance
  7. 7.EA PI3 Pathophysiology of injury-induced immunosuppressionUniversité Claude Bernard Lyon 1LyonFrance
  8. 8.FHU IRIS, Department of Neurology, Stroke Unit, Hospices Civils de LyonHôpital Neurologique Pierre WertheimerBronFrance
  9. 9.Division of Health SciencesThe University of Warwick, Warwick Medical SchoolCoventryEngland

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