PURPOSE: Endovascular treatment (EVT) of tandem lesion (TL) in anterior circulation (AC) acute ischemic stroke (AIS) represents still a clinical challenge. We aimed to evaluate selected factors related to EVT and assess other possible predictors of good clinical outcome besides the generally known ones. METHODS: AIS patients with TL in AC treated with EVT were enrolled in the multicenter retrospective ASCENT study. A good three-month clinical outcome was scored as 0-2 points in modified Rankin Scale (mRS) and achieved recanalization using the TICI scale. Symptomatic intracerebral hemorrhage (SICH) was assessed using the SITS-MOST criteria. Logistic regression analysis was used for the assessment of possible predictors of mRS 0-2 with adjustment for potential confounders. RESULTS: In total, 300 (68.7% males, mean age 67.3 ± 10.2 years) patients with median of admission NIHSS 17 were analyzed. Recanalization (TICI 2b-3) was achieved in 290 (96.7%) patients and 176 (58.7%) had mRS 0-2. Besides the age, admission NIHSS and SICH, admission glycemia (p = 0.005, OR: 0.884) the stent patency within the first 30 days after EVT (p = 0.0003, OR: 0.219), dual antiplatelet therapy (DAPT) started within 12 h after EVT (p < 0.0001, OR: 5.006) and statin therapy started within 24 h after stenting (p < 0.0001, OR: 5.558) were found as other predictors. CONCLUSION: Admission glycemia, start of DAPT within 12 h and statin therapy within 24 h after EVT, and stent patency within the first 30 days after EVT were found as other predictors of good three-month clinical outcome in AIS patients treated with EVT for TL.

Comprehensive Stroke Center Department of Neurology Central Military Hospital Prague Prague Czech Republic

Comprehensive Stroke Center Department of Neurology Masaryk Hospital KZ a S Ústí Nad Labem Czech Republic

Comprehensive Stroke Center Department of Neurology Palacký University Medical School and University Hospital Olomouc Olomouc Czech Republic

Department of Biophysics and Statistics Palacký University Medical School Olomouc Olomouc Czech Republic

Department of Neurology P J Šafarik University Faculty of Medicine and University Hospital L Pasteur Košice Košice Slovakia

Department of Radiodiagnostics and Imagine Techniques P J Šafarik University Faculty of Medicine and University Hospital L Pasteur Košice Košice Slovakia

Department of Radiology Central Military Hospital Prague Prague Czech Republic

Department of Radiology J E Purkinje University Masaryk Hospital KZ a S Ústí Nad Labem Czech Republic

Department of Radiology Palacký University Medical School and University Hospital Olomouc Olomouc Czech Republic

See more in PubMed

Powers WJ, Rabinstein AA, Ackerson T, et al. On behalf of the American heart association stroke council. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke a guideline for healthcare professionals from the American heart association/American stroke association. Stroke. 2019;50:e344–e418. doi: 10.1161/STR.0000000000000211. PubMed DOI

Turc G, Bhogal P, Fischer U, et al. European stroke organisation (ESO)—European society for minimally invasive neurological therapy (ESMINT) guidelines on mechanical thrombectomy in acute ischaemic stroke endorsed by stroke alliance for Europe (SAFE) Eur Stroke J. 2019;4(1):6–12. doi: 10.1177/2396987319832140. PubMed DOI PMC

Turc G, Tsivgoulis G, Audebert HJ, et al. European stroke organisation—European society for minimally invasive neurological therapy expedited recommendation on indication for intravenous thrombolysis before mechanical thrombectomy in patients with acute ischaemic stroke and anterior circulation large vessel occlusion. Eur Stroke J. 2022;7(1):1–26. doi: 10.1177/23969873221076968. PubMed DOI PMC

Diana F, Romoli M, Toccaceli G, et al. Emergent carotid stenting versus no stenting for acute ischemic stroke due to tandem occlusion: a meta-analysis. J Neurointerv Surg. 2023;15(5):428–432. doi: 10.1136/neurintsurg-2022-018683. PubMed DOI

Diana F, Abdalkader M, Behme D, et al. Antithrombotic regiment in emergent carotid stenting for acute ischemic stroke due to tandem occlusion: a meta-analysis of aggregate data. J Neurointerv Surg. 2023 doi: 10.1136/jnis-2023-020204. PubMed DOI

Yahia MI, Marnat G, Finitsis S, et al. Acute carotid stenting plus aspirin during thrombectomy of tandem occlusions: a matched case-control study. Interv Neuroradiol. 2023 doi: 10.1177/15910199231175375. PubMed DOI

Nolan NM, Regenhardt RW, Koch MJ, et al. Treatment approaches and outcomes for acute anterior circulation stroke patients with tandem lesions. J Stroke Cerebrovasc Dis. 2021;30(2):105478. doi: 10.1016/j.jstrokecerebrovasdis.2020.105478. PubMed DOI PMC

Anadani M, Marnat G, Consoli A, et al. Endovascular therapy with or without intravenous thrombolysis in acute stroke with tandem occlusion. J NeuroIntervent Surg. 2021 doi: 10.1136/neurintsurg-2020-017202. PubMed DOI

Ngankou EH, Gory B, Marnat G, et al. Thrombectomy complications in large vessel occlusions: incidence, predictors, and clinical impact in the ETIS registry. Stroke. 2021;52:e764–e768. doi: 10.1161/STROKEAHA.121.034865. PubMed DOI

Anadani M, Marnat G, Consoli A, et al. Endovascular therapy of anterior circulation tandem occlusions pooled analysis from the TITAN and ETIS registries. Stroke. 2021;52:3097–3105. doi: 10.1161/STROKEAHA.120.033032. PubMed DOI

Cirillo L, Romano DG, Vornetti G, et al. Acute ischemic stroke with cervical internal carotid artery steno-occlusive lesion: multicenter analysis of endovascular approaches. BMC Neurol. 2021;21:362. doi: 10.1186/s12883-021-02393-4. PubMed DOI PMC

Jadhav AP, Zaidat OO, Liebeskind DS, et al. Emergent management of tandem lesions in acute ischemic stroke. Stroke. 2019;50:428–433. doi: 10.1161/STROKEAHA.118.021893. PubMed DOI

Poppe AY, Jacquin G, Roy D, et al. Tandem carotid lesions in acute ischemic stroke: mechanisms, therapeutic challenges, and future directions. AJNR Am J Neuroradiol. 2020;41:1142–1148. doi: 10.3174/ajnr.A6582. PubMed DOI PMC

Zhang J, Chen S, Shi S, et al. Direct endovascular treatment versus bridging therapy in patients with acute ischemic stroke eligible for intravenous thrombolysis: systematic review and meta-analysis. J NeuroIntervent Surg. 2022;14:321–325. doi: 10.1136/neurintsurg-2021-017928. PubMed DOI

Sanak D, Kocher M, Zapletalova K, et al. Endovascular treatment for acute ischemic stroke with tandem lesion in the anterior circulation: analysis from the METRICS study. J Neurointerv Surg. 2022 doi: 10.1136/jnis-2022-019176. PubMed DOI

Yang P, Zhang Y, Zhang L, et al. Endovascular thrombectomy with or without intravenous alteplase in acute stroke. N Engl J Med. 2020;382:1981–1993. doi: 10.1056/NEJMoa2001123. PubMed DOI

Higashida RT, Furlan AJ. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke. 2003;34:109–137. doi: 10.1161/01.STR.0000082721.62796.09. PubMed DOI

Wahlgren N, Ahmed N, Eriksson N, et al. Safe implementation of thrombolysis in stroke-MOnitoring STudy investigators. Multivariable analysis of outcome predictors and adjustment of main outcome results to baseline data profile in randomized controlled trials: Safe Implementation of Thrombolysis in Stroke-MOnitoring STudy (SITS-MOST) Stroke. 2008;39:3316–3322. doi: 10.1161/STROKEAHA.107.510768. PubMed DOI

Marnat G, Finistis S, Moreno R, et al. Aspirin versus aggressive antiplatelet therapy for acute carotid stenting plus thrombectomy in tandem occlusions: ETIS Registry results. J Neurointerv Surg. 2022 doi: 10.1136/jnis-2022-019527. PubMed DOI

Curró CT, Fiume G, Cotroneo M, et al. Ischemic stroke and reperfusion therapies in diabetic patients. Neurol Sci. 2022;43(7):4335–4348. doi: 10.1007/s10072-022-05935-x. PubMed DOI

Baudu J, Gerbaud E, Catargi B, et al. High glycemic variability: An underestimated determinant of stroke functional outcome following large vessel occlusion. Rev Neurol (Paris) 2022;178(7):732–740. doi: 10.1016/j.neurol.2021.12.010. PubMed DOI

Šaňák D, Černík D, Divišová P, et al. Low levels of glycemia within the first 48 hours after mechanical thrombectomy for acute ischemic stroke may be associated with better clinical outcome. J Stroke Cerebrovasc Dis. 2020;29(4):104621. doi: 10.1016/j.jstrokecerebrovasdis.2019.104621. PubMed DOI

Uchida K, Yoshimura S, Imamura H, et al. Effect of statin administration after onset of acute ischemic stroke with large vessel occlusion: insights from RESUCE Japan Registry 2. JAMA. 2020;9(23):e017472. doi: 10.1161/JAHA.120.017472. PubMed DOI PMC

Hellegering J, Uyttenboogaart M, Bokkers RPH, et al. Treatment of the extracranial carotid artery in tandem lesions during endovascular treatment of acute ischemic stroke: a systematic review and meta-analysis. Ann Transl Med. 2020;8(19):1278. doi: 10.21037/atm-2020-cass-1. PubMed DOI PMC

Curro CT, Fiume G, Cotroneo M, et al. Ischemic stroke and reperfusion therapies in diabetic patients. Neurol Sci. 2022;43:4335–4348. doi: 10.1007/s10072-022-05935-x. PubMed DOI

Suissa L, Panicucci E, Perot Ch, et al. Effect of hyperglycemia on stroke outcome is not homogenous to all patients treated with mechanical thrombectomy. Clin Neurol Neurosurg. 2020;194:105750. doi: 10.1016/j.clineuro.2020.105750. PubMed DOI