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

Authors

Milagros Galecio-Castillo
Michael Abraham
Mudassir Farooqui, University of Iowa
Ameer E. Hassan, Valley Baptist Medical Center, University of Texas Rio Grande ValleyFollow
Afshin A. Divani
Mouhammad A. Jumaa
Marc Ribo
Nils Petersen
Johanna T. Fifi
Wondwossen G. Tekle, The University of Texas Rio Grande Valley

Document Type

Article

Publication Date

12-2023

Abstract

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.

Comments

PMC Copyright notice

Recommended Citation

Galecio-Castillo, M., Abraham, M., Farooqui, M., Hassan, A. E., Divani, A. A., Jumaa, M. A., Ribo, M., Petersen, N., Fifi, J., Guerrero, W. R., Malik, A. M., Siegler, J. E., Nguyen, T. N., Sheth, S. A., Yoo, A. J., Linares, G., Janjua, N., Quispe-Orozco, D., Qureshi, A., Tekle, W. G., … Ortega-Gutierrez, S. (2023). Endovascular treatment of acute ischemic stroke patients with tandem lesions: antegrade versus retrograde approach. Journal of neurosurgery, 140(6), 1726–1735. https://doi.org/10.3171/2023.10.JNS231702

Publication Title

Journal of neurosurgery

DOI

10.3171/2023.10.JNS231702

Academic Level

faculty

Mentor/PI Department

Neurology