Post-Doctoral Research Fellow University of Pennsylvania Department of Neurosurgery Alexandria, Egypt
Disclosure(s):
Mohamed M. Salem, MD, MPH: No financial relationships to disclose
Introduction: Scarce amount of data exist regarding mechanical thrombectomy (MT) outcomes in posterior circulation tandem occlusions, with most available data limited to small single-center series.
Methods: Series of consecutive patients undergoing MT for tandem posterior occlusions from 7 US centers (2016-2021) were included. Inclusion criteria were patients with posterior circulation stroke due to intracranial VA, BA, or PCA occlusion (distal lesion), with tandem occlusion defined as stenosis/occlusion of the extracranial VA with resultant impaired flow (proximal lesion) rendering potential treatment. Primary radiological outcome was successful recanalization defined as mTICI score of ≥2b, with clinical endpoint of MT safety and functional outcomes utilizing modified Rankin Scale (mRS) at 90-days/last available follow-up.
Results: 79 patients were included (mean age 63±15 years, 35.4% females). Median initial NIHSS score was 16 (IQR 9-26); pre-procedural intravenous thrombolytic therapy was utilized in 27.8% of patients (95.5% received tPA), with 68.4% of procedures utilizing general anesthesia. The most used first-line MT technique included primary aspiration catheters in 40.5% of the cases followed by a combination of SR+ADAPT in 29.1%, and eventual rescue stenting in 46.8% of cases. Median time from last-known-well to puncture time was 6.1 hours (IQR 3.9–13.2), with median time from puncture-to-recanalization of 57 minutes (IQR 32.5–93). For distal lesions, mean number of passes was 1.6±1.3, while for proximal lesions, endovascular revascularization was performed in 74.7% of cases, with mean number 1.4±0.8 of passes. Successful revascularization occurred in 83.5% of procedures. In terms of periprocedural complications, dissection occurred in 2.5%, vessel perforation 3.8%, and immediate vessel re-occlusion in 3.8% (requiring rescue stenting). Post-procedural symptomatic intracerebral hemorrhage occurred in 5.1% of the cases. Favorable clinical outcomes (90-day mRS 0-3) was documented in 44.9% of the patients, with 37.2% mortality rate.
Conclusion : MT for posterior circulation tandem occlusions is feasible with reasonable clinical outcomes, despite a high rate of rescue stenting.
