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J. Clin. Med. 2019, 8(2), 228; https://doi.org/10.3390/jcm8020228

Endovascular Therapy for Tandem Occlusion in Acute Ischemic Stroke: Intravenous Thrombolysis Improves Outcomes

1
Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, 5020 Salzburg, Austria
2
Department of Neurology, University Medical Center Maribor, Maribor 2000, Slovenia
3
Department of Neurology, King’s College Hospital, Denmark Hill, London SE5 9RS, UK
4
Research Institute for Neurointervention, Christian Doppler Medical Center, Paracelsus Medical University, 5020 Salzburg, Austria
5
Department of Anesthesiology, General Hospital Varazdin, 42000 Varazdin, Croatia
6
Department of Neurology, Klinikum rechts der Isar, Technische Universität München, 81675 München, Germany
*
Author to whom correspondence should be addressed.
These authors contributed equally to the manuscript.
Received: 4 January 2019 / Revised: 30 January 2019 / Accepted: 7 February 2019 / Published: 10 February 2019
(This article belongs to the Special Issue Cardiovascular and Neurological Emergency)
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Abstract

Ischemic stroke related to tandem internal carotid and middle cerebral artery (TIM) occlusion is a challenging condition where endovascular treatment (EVT) is an emerging revascularization option. The identification of factors influencing clinical outcomes can assist in creating appropriate therapeutic algorithms for such patients. This study aimed to evaluate prognostic factors in the context of EVT for TIM occlusion. We performed a retrospective study of consecutive patients with TIM occlusion admitted within 6 h from symptom onset to two tertiary stroke centers. We recorded the etiology of stroke, clinical deficits at stroke onset and discharge, details of EVT, final infarct volume (FIV), in-hospital mortality, and outcome at three months. Among 73 patients with TIM occlusion, 53 were treated with EVT. The median age was 75.9 years (interquartile range (IQR) 64.6–82.6), with the most common etiology of cardioembolism (51.9%). Intravenous thrombolysis with tissue-plasminogen activator (t-PA) was performed in the majority (69.8%) of cases. EVT achieved successful recanalization with a thrombolysis in cerebral infarction (TICI) grade of 2b or 3 in 67.9%. A good outcome (modified Rankin score of 0–2 at three months) was observed in 37.7%. After adjustment for age, the National Institutes of Health Stroke Scale (NIHSS) at admission, and success of recanalization, smaller final infarct volume (odds ratio (OR) 0.021 for FIV above 25th percentile (95% CI 0.001–0.332, p = 0.005)) and administration of intravenous t-PA (OR 12.04 (95% CI 1.004–144.392, p = 0.049)) were associated with a good outcome at three months. Our study demonstrates that bridging with t-PA is associated with improved outcomes in the setting of tandem ICA and MCA occlusions treated with EVT and should therefore not be withheld in eligible patients. View Full-Text
Keywords: ischemic stroke; tandem occlusion; endovascular therapy; intravenous thrombolysis ischemic stroke; tandem occlusion; endovascular therapy; intravenous thrombolysis
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Pikija, S.; Magdic, J.; Sztriha, L.K.; Killer-Oberpfalzer, M.; Bubel, N.; Lukic, A.; Sellner, J. Endovascular Therapy for Tandem Occlusion in Acute Ischemic Stroke: Intravenous Thrombolysis Improves Outcomes. J. Clin. Med. 2019, 8, 228.

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