Endovascular treatment of tandem extracranial/intracranial anterior circulation occlusions

Preliminary single-center experience

Amer Malik, Nirav A. Vora, Ridwan Lin, Syed F. Zaidi, Aitziber Aleu, Brian T. Jankowitz, Mouhammad A. Jumaa, Vivek K. Reddy, Maxim D. Hammer, Lawrence R. Wechsler, Michael B. Horowitz, Tudor G. Jovin

Research output: Contribution to journalArticle

82 Citations (Scopus)

Abstract

Background And Purpose- Acute ischemic stroke due to tandem occlusions of the extracranial internal carotid artery and intracranial arteries has a poor natural history. We aimed to evaluate our single-center experience with endovascular treatment of this unique stroke population. Methods- Consecutive patients with tandem occlusions of the internal carotid artery origin and an intracranial artery (ie, internal carotid artery terminus, M1 middle cerebral artery, or M2 middle cerebral artery) were studied retrospectively. Treatment consisted of proximal revascularization with angioplasty and stenting followed by intracranial intervention. Endpoints were recanalization of both extracranial and intracranial vessels (Thrombolysis In Myocardial Ischemia 2), parenchymal hematoma, and good clinical outcome (modified Rankin Scale ≤2) at 3 months. Results- We identified 77 patients with tandem occlusions. Recanalization occurred in 58 cases (75.3%) and parenchymal hematoma occurred in 8 cases (10.4%). Distal embolization occurred in 3 cases (3.9%). In 18 of 77 patients (23.4%), distal (ie, intracranial) recanalization was observed after proximal recanalization, obviating the need for distal intervention. Good clinical outcomes were achieved in 32 patients (41.6%). In multivariate analysis, Thrombolysis In Myocardial Ischemia 2 recanalization, baseline National Institutes of Health Stroke Scale score, baseline Alberta Stroke Programme Early CT score, and age were significantly associated with good outcome. Conclusions- Endovascular therapy of tandem occlusions using extracranial internal carotid artery revascularization as the first step is technically feasible, has a high recanalization rate, and results in an acceptable rate of good clinical outcome. Future randomized, prospective studies should clarify the role of this approach.

Original languageEnglish (US)
Pages (from-to)1653-1657
Number of pages5
JournalStroke
Volume42
Issue number6
DOIs
StatePublished - Jun 2011
Externally publishedYes

Fingerprint

Internal Carotid Artery
Stroke
Middle Cerebral Artery
Hematoma
Myocardial Ischemia
Arteries
Alberta
National Institutes of Health (U.S.)
Therapeutics
Natural History
Angioplasty
Multivariate Analysis
Prospective Studies
Population

Keywords

  • acute stroke
  • angioplasty and stenting
  • endovascular treatment
  • stenting
  • stents

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Endovascular treatment of tandem extracranial/intracranial anterior circulation occlusions : Preliminary single-center experience. / Malik, Amer; Vora, Nirav A.; Lin, Ridwan; Zaidi, Syed F.; Aleu, Aitziber; Jankowitz, Brian T.; Jumaa, Mouhammad A.; Reddy, Vivek K.; Hammer, Maxim D.; Wechsler, Lawrence R.; Horowitz, Michael B.; Jovin, Tudor G.

In: Stroke, Vol. 42, No. 6, 06.2011, p. 1653-1657.

Research output: Contribution to journalArticle

Malik, A, Vora, NA, Lin, R, Zaidi, SF, Aleu, A, Jankowitz, BT, Jumaa, MA, Reddy, VK, Hammer, MD, Wechsler, LR, Horowitz, MB & Jovin, TG 2011, 'Endovascular treatment of tandem extracranial/intracranial anterior circulation occlusions: Preliminary single-center experience', Stroke, vol. 42, no. 6, pp. 1653-1657. https://doi.org/10.1161/STROKEAHA.110.595520
Malik, Amer ; Vora, Nirav A. ; Lin, Ridwan ; Zaidi, Syed F. ; Aleu, Aitziber ; Jankowitz, Brian T. ; Jumaa, Mouhammad A. ; Reddy, Vivek K. ; Hammer, Maxim D. ; Wechsler, Lawrence R. ; Horowitz, Michael B. ; Jovin, Tudor G. / Endovascular treatment of tandem extracranial/intracranial anterior circulation occlusions : Preliminary single-center experience. In: Stroke. 2011 ; Vol. 42, No. 6. pp. 1653-1657.
@article{ca5b7aead18846579a3506d757b0f7a6,
title = "Endovascular treatment of tandem extracranial/intracranial anterior circulation occlusions: Preliminary single-center experience",
abstract = "Background And Purpose- Acute ischemic stroke due to tandem occlusions of the extracranial internal carotid artery and intracranial arteries has a poor natural history. We aimed to evaluate our single-center experience with endovascular treatment of this unique stroke population. Methods- Consecutive patients with tandem occlusions of the internal carotid artery origin and an intracranial artery (ie, internal carotid artery terminus, M1 middle cerebral artery, or M2 middle cerebral artery) were studied retrospectively. Treatment consisted of proximal revascularization with angioplasty and stenting followed by intracranial intervention. Endpoints were recanalization of both extracranial and intracranial vessels (Thrombolysis In Myocardial Ischemia 2), parenchymal hematoma, and good clinical outcome (modified Rankin Scale ≤2) at 3 months. Results- We identified 77 patients with tandem occlusions. Recanalization occurred in 58 cases (75.3{\%}) and parenchymal hematoma occurred in 8 cases (10.4{\%}). Distal embolization occurred in 3 cases (3.9{\%}). In 18 of 77 patients (23.4{\%}), distal (ie, intracranial) recanalization was observed after proximal recanalization, obviating the need for distal intervention. Good clinical outcomes were achieved in 32 patients (41.6{\%}). In multivariate analysis, Thrombolysis In Myocardial Ischemia 2 recanalization, baseline National Institutes of Health Stroke Scale score, baseline Alberta Stroke Programme Early CT score, and age were significantly associated with good outcome. Conclusions- Endovascular therapy of tandem occlusions using extracranial internal carotid artery revascularization as the first step is technically feasible, has a high recanalization rate, and results in an acceptable rate of good clinical outcome. Future randomized, prospective studies should clarify the role of this approach.",
keywords = "acute stroke, angioplasty and stenting, endovascular treatment, stenting, stents",
author = "Amer Malik and Vora, {Nirav A.} and Ridwan Lin and Zaidi, {Syed F.} and Aitziber Aleu and Jankowitz, {Brian T.} and Jumaa, {Mouhammad A.} and Reddy, {Vivek K.} and Hammer, {Maxim D.} and Wechsler, {Lawrence R.} and Horowitz, {Michael B.} and Jovin, {Tudor G.}",
year = "2011",
month = "6",
doi = "10.1161/STROKEAHA.110.595520",
language = "English (US)",
volume = "42",
pages = "1653--1657",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Endovascular treatment of tandem extracranial/intracranial anterior circulation occlusions

T2 - Preliminary single-center experience

AU - Malik, Amer

AU - Vora, Nirav A.

AU - Lin, Ridwan

AU - Zaidi, Syed F.

AU - Aleu, Aitziber

AU - Jankowitz, Brian T.

AU - Jumaa, Mouhammad A.

AU - Reddy, Vivek K.

AU - Hammer, Maxim D.

AU - Wechsler, Lawrence R.

AU - Horowitz, Michael B.

AU - Jovin, Tudor G.

PY - 2011/6

Y1 - 2011/6

N2 - Background And Purpose- Acute ischemic stroke due to tandem occlusions of the extracranial internal carotid artery and intracranial arteries has a poor natural history. We aimed to evaluate our single-center experience with endovascular treatment of this unique stroke population. Methods- Consecutive patients with tandem occlusions of the internal carotid artery origin and an intracranial artery (ie, internal carotid artery terminus, M1 middle cerebral artery, or M2 middle cerebral artery) were studied retrospectively. Treatment consisted of proximal revascularization with angioplasty and stenting followed by intracranial intervention. Endpoints were recanalization of both extracranial and intracranial vessels (Thrombolysis In Myocardial Ischemia 2), parenchymal hematoma, and good clinical outcome (modified Rankin Scale ≤2) at 3 months. Results- We identified 77 patients with tandem occlusions. Recanalization occurred in 58 cases (75.3%) and parenchymal hematoma occurred in 8 cases (10.4%). Distal embolization occurred in 3 cases (3.9%). In 18 of 77 patients (23.4%), distal (ie, intracranial) recanalization was observed after proximal recanalization, obviating the need for distal intervention. Good clinical outcomes were achieved in 32 patients (41.6%). In multivariate analysis, Thrombolysis In Myocardial Ischemia 2 recanalization, baseline National Institutes of Health Stroke Scale score, baseline Alberta Stroke Programme Early CT score, and age were significantly associated with good outcome. Conclusions- Endovascular therapy of tandem occlusions using extracranial internal carotid artery revascularization as the first step is technically feasible, has a high recanalization rate, and results in an acceptable rate of good clinical outcome. Future randomized, prospective studies should clarify the role of this approach.

AB - Background And Purpose- Acute ischemic stroke due to tandem occlusions of the extracranial internal carotid artery and intracranial arteries has a poor natural history. We aimed to evaluate our single-center experience with endovascular treatment of this unique stroke population. Methods- Consecutive patients with tandem occlusions of the internal carotid artery origin and an intracranial artery (ie, internal carotid artery terminus, M1 middle cerebral artery, or M2 middle cerebral artery) were studied retrospectively. Treatment consisted of proximal revascularization with angioplasty and stenting followed by intracranial intervention. Endpoints were recanalization of both extracranial and intracranial vessels (Thrombolysis In Myocardial Ischemia 2), parenchymal hematoma, and good clinical outcome (modified Rankin Scale ≤2) at 3 months. Results- We identified 77 patients with tandem occlusions. Recanalization occurred in 58 cases (75.3%) and parenchymal hematoma occurred in 8 cases (10.4%). Distal embolization occurred in 3 cases (3.9%). In 18 of 77 patients (23.4%), distal (ie, intracranial) recanalization was observed after proximal recanalization, obviating the need for distal intervention. Good clinical outcomes were achieved in 32 patients (41.6%). In multivariate analysis, Thrombolysis In Myocardial Ischemia 2 recanalization, baseline National Institutes of Health Stroke Scale score, baseline Alberta Stroke Programme Early CT score, and age were significantly associated with good outcome. Conclusions- Endovascular therapy of tandem occlusions using extracranial internal carotid artery revascularization as the first step is technically feasible, has a high recanalization rate, and results in an acceptable rate of good clinical outcome. Future randomized, prospective studies should clarify the role of this approach.

KW - acute stroke

KW - angioplasty and stenting

KW - endovascular treatment

KW - stenting

KW - stents

UR - http://www.scopus.com/inward/record.url?scp=79958273700&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79958273700&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.110.595520

DO - 10.1161/STROKEAHA.110.595520

M3 - Article

VL - 42

SP - 1653

EP - 1657

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 6

ER -