RT Journal Article
SR Electronic
T1 Endovascular treatment for acute ischemic stroke in patients with tandem lesion in the anterior circulation: analysis from the METRICS study
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP e123
OP e128
DO 10.1136/jnis-2022-019176
VO 15
IS e1
A1 Sanak, Daniel
A1 Kocher, Martin
A1 Zapletalova, Jana
A1 Cihlar, Filip
A1 Czerny, Daniel
A1 Cernik, David
A1 Duras, Petr
A1 Fiksa, Jan
A1 Husty, Jakub
A1 Jurak, Lubomir
A1 Kovar, Martin
A1 Lacman, Jiri
A1 Padr, Radek
A1 Prochazka, Pavel
A1 Raupach, Jan
A1 Reiser, Martin
A1 Rohan, Vladimir
A1 Roubec, Martin
A1 Sova, Jindrich
A1 Sercl, Miroslav
A1 Skorna, Miroslav
A1 Simunek, Libor
A1 Snajdrova, Alena
A1 Sramek, Martin
A1 Tomek, Ales
YR 2023
UL http://jnis.bmj.com/content/15/e1/e123.abstract
AB 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.All data relevant to the study are included in the article or uploaded as supplementary information.