Predictors of good functional outcome in patients with Tandem Occlusion after revascularization treatment: single center experience with 12-month follow-up

Objective: The optimal management and procedural strategy for tandem occlusion (TO) in acute ischemic stroke (AIS) are still unclear, as well as the long-term outcome of these patients. The aim of this study was to evaluate predictors of good functional outcome in patients with TO, through the analysis of demographics, clinical and radiological data with one-year follow- up. Methods: We collected data of 100 patients with TO who underwent revascularization treatments in our comprehensive stroke center. We divided patients into two groups, those with good functional outcome, defined as modified Rankin Score (mRS) 0-2, and those with poor functional outcome, defined as mRS 3-6, at 3, 6 and 12-month follow-up. Moreover, we investigated which variables were able to influence mortality. Results: At multivariate analysis, endovascular treatment with mechanical thrombectomy (MT) combined with emergent cervical carotid artery stenting (eCAS) was an independent predictor of good functional outcome at 6 and 12 months (aOR 4.3, CI 1.49-12.31, p=0.007) (aOR 3.5, CI 1.25-9.61, p=0.017) and was associated with a lower rate of mortality at 3 and 6 months follow-up (aOR 0.14, CI 0.04-0.57, p=0.006 and aOR 0.296, CI 0.97-0.902, p=0.032 respectively). Furthermore, smoking habit was associated with a better outcome at 3-month follow-up (aOR 10.7, CI 2.2-51.6, p=0.003) but not at 6- and 12-month. Conclusions: Our research, conducted in a small sample size of patients with AIS due to TO of anterior circulation, found that acute stent placement seems to be safe, improving clinical outcome, and it is associated with low rate of mortality at long-term follow-up.