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.

2nd Department of Internal Medicine General University Hospital Prague Prague Czech Republic

Department of Biophysics and Statistics Palacky University Olomouc Olomouc Czech Republic

Department of Neurology Central Military Hospital Prague Prague Czech Republic

Department of Neurology Charles University Faculty of Medicine and University Hospital Hradec Kralove Hradec Kralove Czech Republic

Department of Neurology Charles University Faculty of Medicine and University Hospital Plzen Plzen Czech Republic

Department of Neurology General University Hospital Prague Prague Czech Republic

Department of Neurology Krajska zdravotni as Masarykova nemocnice v Usti nad Labem oz Usti nad Labem Czech Republic

Department of Neurology Masaryk University Faculty of Medicine and University Hospital Brno Brno Czech Republic

Department of Neurology Motol University Hospital Praha Praha Czech Republic

Department of Neurology Na Homolce Hospital Prague Czech Republic

Department of Neurology Palacký University Faculty of Medicine and University Hospital Olomouc Olomouc Czech Republic

Department of Neurology Regional Hospital Ceske Budejovice Ceske Budejovice Czech Republic

Department of Neurology Regional Hospital Liberec Liberec Czech Republic

Department of Neurology University of Ostrava Faculty of Medicine and University Hospital Ostrava Ostrava Czech Republic

Department of Radiology and Nuclear Medicine University Hospital Brno Brno Czech Republic

Department of Radiology Central Military Hospital Prague Prague Czech Republic

Department of Radiology Charles University Faculty of Medicine and University Hospital Hradec Kralove Hradec Kralove Czech Republic

Department of Radiology Masaryk Hospital in Usti nad Labem Usti nad Labem Czech Republic

Department of Radiology Na Homolce Hospital Prague Prague Czech Republic

Department of Radiology Palacký University Faculty of Medicine and University Hospital Olomouc Olomouc Czech Republic

Department of Radiology Regional Hospital Ceske Budejovice Ceske Budejovice Czech Republic

Department of Radiology Regional Hospital Liberec Liberec Czech Republic

Department of Radiology University Hospital Motol Prague Prague Czech Republic

Department of Radiology University Hospital Ostrava Ostrava Czech Republic

Department of Radiology University Hospital Plzen Plzen Czech Republic

References provided by Crossref.org

Predictors of Good Clinical Outcome After Endovascular Treatment for Acute Ischemic Stroke due to Tandem Lesion in Anterior Circulation: Results from the ASCENT Study