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Thrombectomy in ischemic stroke patients with tandem occlusion in the posterior versus anterior circulation

  • 期刊论文

  • 发表日期：

    2024年6月18日

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  • Manuel Cappellari,
  • Giovanni Pracucci,
  • Valentina Saia,
  • Nicolò Mandruzzato,
  • Francesco Valletta,
  • Fabrizio Sallustio,
  • Ilaria Casetta,
  • Enrico Fainardi,
  • Valerio Da Ros,
  • Marina Diomedi,
  • Francesco Capasso,
  • Patrizia Nencini,
  • Stefano Vallone,
  • Guido Bigliardi,
  • Agostino Tessitore,
  • Paolino La Spina,
  • Sandra Bracco,
  • Rossana Tassi,
  • Mauro Bergui,
  • Paolo Cerrato,
  • Maria Ruggiero,
  • Marco Longoni,
  • Lucio Castellan,
  • Laura Malfatto,
  • Andrea Saletti,
  • Alessandro De Vito,
  • Roberto Menozzi,
  • Umberto Scoditti,
  • Luigi Simonetti,
  • Andrea Zini,
  • Elvis Lafe,
  • Anna Cavallini,
  • Guido Andrea Lazzarotti,
  • Nicola Giannini,
  • Andrea Boghi,
  • Andrea Naldi,
  • Daniele Romano,
  • Rosa Napoletano,
  • Alessio Comai,
  • Enrica Franchini,
  • Nicola Cavasin,
  • Adriana Critelli,
  • Andrea Giorgianni,
  • Lucia Princiotta Cariddi,
  • Vittorio Semeraro,
  • Giovanni Boero,
  • Domenico Sergio Zimatore,
  • Marco Petruzzellis,
  • Francesco Biraschi,
  • Ettore Nicolini,
  • Alessandro Pedicelli,
  • Giovanni Frisullo,
  • Andrea Calzoni,
  • Tiziana Tassinari,
  • Ivan Gallesio,
  • Federica Sepe,
  • Pietro Filauri,
  • Simona Sacco,
  • Emilio Lozupone,
  • Annalisa Rizzo,
  • Michele Besana,
  • Alessia Giossi,
  • Marco Pavia,
  • Paolo Invernizzi,
  • Pietro Amistà,
  • Monia Russo,
  • Francesco Florio,
  • Vincenzo Inchingolo,
  • Marco Filizzolo,
  • Marina Mannino,
  • Salvatore Mangiafico,
  • Danilo Toni

摘要

Background

Mechanical thrombectomy (MT) was found to be beneficial in acute ischemic stroke patients with anterior tandem occlusion (a-TO). Instead, little is known about the effectiveness of MT in stroke patients with posterior tandem occlusion (p-TO). We aimed to compare MT within 24 h from last known well time in ischemic stroke patients with p-TO versus a-TO.

Methods

We conducted a cohort study on prospectively collected data of patients registered in the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) who were treated with MT within 24 h from last known well time for acute ischemic stroke with p-TO (n = 275) or a-TO (n = 1853).

Results

After adjustment for unbalanced pre-procedure variables (year 2015–2021, age, sex, NIHSS score, ASPECTS, and time strata for puncture groin) and pre-stroke mRS score as pre-defined predictor, p-TO was significantly associated with lower probability of mRS score 0–2 (OR 0.415, 95% CI 0.268–0.644) and with higher risk of death (OR 2.813, 95% CI 2.080–3.805) at 3 months. After adjustment for unbalanced procedural and post-procedure variables (IVT, general anesthesia, TICI 3, and 24-h HT) and pre-stroke mRS score as pre-defined predictor, association between p-TO and lower probability of mRS score 0–2 (OR 0.444, 95% CI 0.304–0.649) and association between p-TO and with higher risk of death (OR 2.971, 95% CI 1.993–4.429) remained significant.

Conclusions

MT within 24 h from last known well time in ischemic stroke patients with p-TO versus a-TO was associated with worse outcomes at 3 months.