Background Mechanical thrombectomy (MT) was found to be beneficial in acute ischemic stroke patients with anterior tandem occlusion (a-TO). Instead, little is known about the effectiveness of MT in stroke patients with posterior tandem occlusion (p-TO). We aimed to compare MT within 24 h from last known well time in ischemic stroke patients with p-TO versus a-TO. Methods We conducted a cohort study on prospectively collected data of patients registered in the Italian Registry of Endo- vascular Treatment in Acute Stroke (IRETAS) who were treated with MT within 24 h from last known well time for acute ischemic stroke with p-TO (n = 275) or a-TO (n = 1853). Results After adjustment for unbalanced pre-procedure variables (year 2015–2021, age, sex, NIHSS score, ASPECTS, and time strata for puncture groin) and pre-stroke mRS score as pre-defined predictor, p-TO was significantly associated with lower probability of mRS score 0–2 (OR 0.415, 95% CI 0.268–0.644) and with higher risk of death (OR 2.813, 95% CI 2.080–3.805) at 3 months. After adjustment for unbalanced procedural and post-procedure variables (IVT, general anesthesia, TICI 3, and 24-h HT) and pre-stroke mRS score as pre-defined predictor, association between p-TO and lower probability of mRS score 0–2 (OR 0.444, 95% CI 0.304–0.649) and association between p-TO and with higher risk of death (OR 2.971, 95% CI 1.993–4.429) remained significant. Conclusions MT within 24 h from last known well time in ischemic stroke patients with p-TO versus a-TO was associated with worse outcomes at 3 months.
Thrombectomy in ischemic stroke patients with tandem occlusion in the posterior versus anterior circulation / Cappellari, Manuel; Pracucci, Giovanni; Saia, Valentina; Mandruzzato, Nicolò; Valletta, Francesco; Sallustio, Fabrizio; Casetta, Ilaria; Fainardi, Enrico; Da Ros, Valerio; Diomedi, Marina; Capasso, Francesco; Nencini, Patrizia; Vallone, Stefano; Bigliardi, Guido; Tessitore, Agostino; La Spina, Paolino; Bracco, Sandra; Tassi, Rossana; Bergui, Mauro; Cerrato, Paolo; Ruggiero, Maria; Longoni, Marco; Castellan, Lucio; Malfatto, Laura; Saletti, Andrea; De Vito, Alessandro; Menozzi, Roberto; Scoditti, Umberto; Simonetti, Luigi; Zini, Andrea; Lafe, Elvis; Cavallini, Anna; Lazzarotti, Guido Andrea; Giannini, Nicola; Boghi, Andrea; Naldi, Andrea; Romano, Daniele; Napoletano, Rosa; Comai, Alessio; Franchini, Enrica; Cavasin, Nicola; Critelli, Adriana; Giorgianni, Andrea; Cariddi, Lucia Princiotta; Semeraro, Vittorio; Boero, Giovanni; Zimatore, Domenico Sergio; Petruzzellis, Marco; Biraschi, Francesco; Nicolini, Ettore; Pedicelli, Alessandro; Frisullo, Giovanni; Calzoni, Andrea; Tassinari, Tiziana; Gallesio, Ivan; Sepe, Federica; Filauri, Pietro; Sacco, Simona; Lozupone, Emilio; Rizzo, Annalisa; Besana, Michele; Giossi, Alessia; Pavia, Marco; Invernizzi, Paolo; Amistà, Pietro; Russo, Monia; Florio, Francesco; Inchingolo, Vincenzo; Filizzolo, Marco; Mannino, Marina; Mangiafico, Salvatore; Toni, Danilo; Null, Null. - In: NEUROLOGICAL SCIENCES. - ISSN 1590-1874. - (2024). [10.1007/s10072-024-07638-x]
Thrombectomy in ischemic stroke patients with tandem occlusion in the posterior versus anterior circulation
Biraschi, Francesco;Nicolini, Ettore;Toni, Danilo;
2024
Abstract
Background Mechanical thrombectomy (MT) was found to be beneficial in acute ischemic stroke patients with anterior tandem occlusion (a-TO). Instead, little is known about the effectiveness of MT in stroke patients with posterior tandem occlusion (p-TO). We aimed to compare MT within 24 h from last known well time in ischemic stroke patients with p-TO versus a-TO. Methods We conducted a cohort study on prospectively collected data of patients registered in the Italian Registry of Endo- vascular Treatment in Acute Stroke (IRETAS) who were treated with MT within 24 h from last known well time for acute ischemic stroke with p-TO (n = 275) or a-TO (n = 1853). Results After adjustment for unbalanced pre-procedure variables (year 2015–2021, age, sex, NIHSS score, ASPECTS, and time strata for puncture groin) and pre-stroke mRS score as pre-defined predictor, p-TO was significantly associated with lower probability of mRS score 0–2 (OR 0.415, 95% CI 0.268–0.644) and with higher risk of death (OR 2.813, 95% CI 2.080–3.805) at 3 months. After adjustment for unbalanced procedural and post-procedure variables (IVT, general anesthesia, TICI 3, and 24-h HT) and pre-stroke mRS score as pre-defined predictor, association between p-TO and lower probability of mRS score 0–2 (OR 0.444, 95% CI 0.304–0.649) and association between p-TO and with higher risk of death (OR 2.971, 95% CI 1.993–4.429) remained significant. Conclusions MT within 24 h from last known well time in ischemic stroke patients with p-TO versus a-TO was associated with worse outcomes at 3 months.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
