Publication details

Endovascular treatment for acute ischemic stroke in patients with tandem lesion in the anterior circulation: analysis from the METRICS study

Authors	SANAK Daniel KOCHER Martin ZAPLETALOVA Jana CIHLAR Filip CZERNY Daniel CERNIK David DURAS Petr FIKSA Jan HUSTÝ Jakub JURAK Lubomir KOVAR Martin LACMAN Jiri PADR Radek PROCHAZKA Pavel RAUPACH Jan REISER Martin ROHAN Vladimir ROUBEC Martin SOVA Jindrich SERCL Miroslav ŠKORŇA Miroslav SIMUNEK Libor SNAJDROVA Alena SRAMEK Martin TOMEK Ales
Year of publication	2023
Type	Article in Periodical
Magazine / Source	Journal of NeuroInterventional Surgery
MU Faculty or unit	Faculty of Medicine
Citation
Web	https://jnis.bmj.com/content/early/2022/08/24/jnis-2022-019176
Doi	http://dx.doi.org/10.1136/jnis-2022-019176
Keywords	Stroke; Thrombectomy; Stent
Description	Background Acute ischemic stroke (AIS) due to anterior circulation tandem lesion (TL) remains a technical and clinical challenge for endovascular treatment (EVT). Conflicting results from observational studies and missing evidence from the randomized trials led us to report a recent real-world multicenter clinical experience and evaluate possible predictors of good outcome after EVT. Methods We analyzed all AIS patients with TL enrolled in the prospective national study METRICS (Mechanical Thrombectomy Quality Indicators Study in Czech Stroke Centers). A good 3-month clinical outcome was scored as 0-2 points in modified Rankin Scale (mRS), achieved recanalization using the Thrombolysis In Cerebral Infarction (TICI) scale and symptomatic intracerebral hemorrhage (sICH) according to the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) criteria. Results Of 1178 patients enrolled in METRICS, 194 (19.2%) (59.8% males, mean age 68.7 +/- 11.5 years) were treated for TL. They did not differ in mRS 0-2 (48.7% vs 46.7%; p=0.616), mortality (17.3% vs 22.7%; p=0.103) and sICH (4.7% vs 5.1%; p=0.809) from those with single occlusion (SO). More TL patients with prior intravenous thrombolysis (IVT) reached TICI 3 (70.3% vs 50.8%; p=0.012) and mRS 0-2 (55.4% vs 34.4%; p=0.007) than those without IVT. No difference was found in the rate of sICH (6.2% vs 1.6%; p=0.276). Multivariate logistic regression analysis showed prior IVT as a predictor of mRS 0-2 after adjustment for potential confounders (OR 3.818, 95% CI 1.614 to 9.030, p=0.002). Conclusion Patients with TL did not differ from those with SO in outcomes after EVT. TL patients with prior IVT had more complete recanalization and mRS 0-2 and IVT was found to be a predictor of good outcome after EVT.