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Clinical Outcomes of Mechanical Thrombectomy in Stroke Tandem Lesions According to Intracranial Occlusion Location

Irene Escudero-Martínez|Blanca Pardo-Galiana|Francisco Moniche|Joan Montaner|Elena Zapata-Arriaza|Asier de Albóniga-Chindurza|Joaquin Ortega-Quintanilla|Manuel Medina-Rodríguez|Juan Antonio Cabezas Rodríguez|Lucía Lebrato Hernández|Leire Ainz|Soledad Pérez-Sánchez|Ana Domínguez-Mayoral|Ana Barragán|Aurelio Cayuela|Alejandro González García
대한뇌졸중학회 (The Korean Stroke Society)|2021.01|대한뇌졸중영문학회지 (Journal of stroke)|제23권 제1호|pp. 124-127|DOI 10.5853/jos.2020.02747

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초록

Tandem lesions (TLs), depict around 20% of acute ischemic stroke (AIS) in patients with large vessel occlusion (LVO).1 TL are poorly represented in thrombectomy clinical trials,2 leading to uncertainty in the homogenization of the therapeutic strategy.3 Clinical benefit of mechanical thrombectomy (MT) in LVO alone is clear2 and untreated AIS due to tandem occlusions generally has a poor prognosis.4 There is growing evidence about efficacy and safety of MT in TL.5,6 However, the evidence of intracranial lesion impact on endovascular treatment in TL is still lacking.

Abstract

Tandem lesions (TLs), depict around 20% of acute ischemic stroke (AIS) in patients with large vessel occlusion (LVO).1 TL are poorly represented in thrombectomy clinical trials,2 leading to uncertainty in the homogenization of the therapeutic strategy.3 Clinical benefit of mechanical thrombectomy (MT) in LVO alone is clear2 and untreated AIS due to tandem occlusions generally has a poor prognosis.4 There is growing evidence about efficacy and safety of MT in TL.5,6 However, the evidence of intracranial lesion impact on endovascular treatment in TL is still lacking.

참고문헌 (14)

  1. Assis Z, "Acute ischemic stroke with tandem lesions : technical endovascular management and clinical outcomes from the ESCAPE trial", J Neurointerv Surg, 10, pp.429~433 (2018)
  2. Goyal M, "Endovascular thrombectomy after largevessel ischaemic stroke : a meta-analysis of individual patient data from five randomised trials", Lancet, 387, pp.1723~1731 (2016)
  3. Jacquin G, "Lack of consensus among stroke experts on the optimal management of patients with acute tandem occlusion", Stroke, 50, pp.1254~1256 (2019)
  4. Rubiera M, "Tandem internal carotid artery", middle cerebral artery occlusion : an independent predictor of poor outcome after systemic thrombolysis, 2006, pp.37, 2301~2305
  5. Bücke P, "Functional outcome and safety of intracranial thrombectomy after emergent extracranial stenting in acute ischemic stroke due to tandem occlusions", Front Neurol, 9, pp.940~ (2018)
  6. Sivan-Hoffmann R, "Stent-retriever thrombectomy for acute anterior ischemic stroke with tandem occlusion : a systematic review and meta-analysis", Eur Radiol, 27, pp.247~254 (2017)
  7. Nogueira RG, "Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct", N Engl J Med, 378, pp.11~21 (2018)
  8. Albers GW, "Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging", N Engl J Med, 378, pp.708~718 (2018)
  9. Higashida RT, "Trial design and reporting standards for intraarterial cerebral thrombolysis for acute ischemic stroke", Stroke, 34, pp.e109~ (2003)
  10. Rangel-Castilla L, "Management of acute ischemic stroke due to tandem occlusion : should endovascular recanalization of the extracranial or intracranial occlusive lesion be done first", Neurosurg Focus, 42, pp.E16~ (2017)
  11. Sadeh-Gonik U, "Thrombectomy outcomes for acute stroke patients with anterior circulation tandem lesions : a clinical registry and an update of a systematic review with meta-analysis", Eur J Neurol, 25, pp.693~700 (2018)
  12. Powers WJ, "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, 2019, pp.50, e344~e418
  13. Demchuk AM, "Recanalization and clinical outcome of occlusion sites at baseline CT angiography in the Interventional Management of Stroke III trial", Radiology, 273, pp.202~210 (2014)
  14. Alawieh A, "Technical and clinical outcomes after thrombectomy for the various segments of the middle cerebral artery", World Neurosurg, 128, pp.e445~e453 (2019)

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