Endovascular treatment of acute ischemic stroke patients with tandem lesions: antegrade versus retrograde approach.

Autor:	Galecio-Castillo M; 1Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa., Abraham M; 2Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas., Farooqui M; 1Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa., Hassan AE; 3Department of Neurology, Valley Baptist Medical Center, University of Texas Rio Grande Valley, Harlingen, Texas., Divani AA; 4Department of Neurology, University of New Mexico Health Science Center, Albuquerque, New Mexico., Jumaa MA; 5Department of Neurology, ProMedica Toledo Hospital, Toledo, Ohio., Ribo M; 6Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain., Petersen N; 7Department of Neurology, Yale University School of Medicine, New Haven, Connecticut., Fifi J; 8Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York., Guerrero WR; 9Department of Neurology and Brain Repair, University of South Florida, Tampa, Florida., Malik AM; 10Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida., Siegler JE; 11Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey.; 12Cooper Medical School of Rowan University, Camden, New Jersey., Nguyen TN; 13Department of Neurology, Boston Medical Center, Boston, Massachusetts., Sheth SA; 14Department of Neurology, UT Health McGovern Medical School, Houston, Texas., Yoo AJ; 15Texas Stroke Institute, Dallas-Fort Worth, Fort Worth, Texas., Linares G; 16Department of Neurology, Saint Louis University, St. Louis, Missouri., Janjua N; 17Asia Pacific Comprehensive Stroke Institute, Pomona Valley Hospital Medical Center, Pomona, California; and., Quispe-Orozco D; 1Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa., Qureshi A; 2Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas., Tekle WG; 3Department of Neurology, Valley Baptist Medical Center, University of Texas Rio Grande Valley, Harlingen, Texas., Ikram A; 4Department of Neurology, University of New Mexico Health Science Center, Albuquerque, New Mexico., Zaidi SF; 5Department of Neurology, ProMedica Toledo Hospital, Toledo, Ohio., Zevallos CB; 1Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa., Taborda B; 6Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain., Devarajan A; 8Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York., Zhang L; 12Cooper Medical School of Rowan University, Camden, New Jersey., Abdalkader M; 13Department of Neurology, Boston Medical Center, Boston, Massachusetts., Salazar-Marioni S; 14Department of Neurology, UT Health McGovern Medical School, Houston, Texas., Soomro J; 15Texas Stroke Institute, Dallas-Fort Worth, Fort Worth, Texas., Gordon W; 16Department of Neurology, Saint Louis University, St. Louis, Missouri., Rodriguez-Calienes A; 1Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.; 18Department of Neuroscience, Clinical Effectiveness and Public Health Research Group, Universidad Científica del Sur, Lima, Peru., Vivanco-Suarez J; 1Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa., Woolfolk K; 17Asia Pacific Comprehensive Stroke Institute, Pomona Valley Hospital Medical Center, Pomona, California; and., Mokin M; 9Department of Neurology and Brain Repair, University of South Florida, Tampa, Florida., Yavagal DR; 10Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida., Ortega-Gutierrez S; 1Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery [J Neurosurg] 2023 Dec 29; Vol. 140 (6), pp. 1726-1735. Date of Electronic Publication: 2023 Dec 29 (Print Publication: 2024).
DOI:	10.3171/2023.10.JNS231702
Abstrakt:	Objective: The optimal technique for treating tandem lesions (TLs) with endovascular therapy is debatable. The authors evaluated the functional, safety, and procedural outcomes of different approaches in a multicenter study. Methods: Anterior circulation TL patients treated from January 2015 to December 2020 were divided on the basis of antegrade versus retrograde approach and included. The evaluated outcomes were favorable modified Rankin Scale (mRS) score (mRS score 0-2) at 3 months, ordinal shift in mRS score, successful recanalization, excellent recanalization, first-pass effect (FPE), time from groin puncture to successful recanalization, symptomatic intracranial hemorrhage (sICH), and 90-day mortality. Results: Among 691 patients treated at 16 centers, 286 patients (174 antegrade and 112 retrograde approach patients) with acute stenting were included in the final analysis. There were no significant differences in mRS score 0-2 at 90 days (52.2% vs 50.0%, adjusted odds ratio [aOR] 0.83, 95% CI 0.42-1.56, p = 0.54), favorable shift in 90-day mRS score (aOR 1.03, 95% CI 0.66-1.29, p = 0.11), sICH (4.0% vs 4.5%, aOR 0.64, 95% CI 0.24-1.51, p = 0.45), successful recanalization (89.4% vs 93%, aOR 0.49, 95% CI 0.19-1.28, p = 0.19), excellent recanalization (51.4% vs 58.9%, aOR 0.59, 95% CI 0.40-1.07, p = 0.09), FPE (58.3% vs 69.7%, aOR 0.62, 95% CI 0.44-1.15, p = 0.21), and mortality at 90 days (16.6% vs 14.0%, aOR 0.94, 95% CI 0.35-2.44, p = 0.81) between the groups. The median (interquartile range) groin puncture to recanalization time was significantly longer in the antegrade group (59 [43-90] minutes vs 49 [35-73] minutes, p = 0.036). Conclusions: The retrograde approach was associated with faster recanalization times with a similar functional and safety profile when compared with the antegrade approach in patients with acute ischemic stroke with TL.
Databáze:	MEDLINE
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