Efficacy And Safety Of Endovascular Treatment For Acute Anterior Circulation Tandem Lesions

Objective: To explore the efficacy and safety of early endovascular therapy(EVT)for patients with tandem lesions.Methods: Patients with acute large vascular occlusion stroke(ALVOS)who underwent early EVT in the Yijishan Hospital of Wannan Medical College from September 2015 to December 2019 were retrospective collected.According to whether the proximal occluded vascular combined with occlusions / severe stenosis(≥70%)or not,the patients were divided into tandem lesions group and single vascular group.To minimize the case bias,propensity score matching was performed.The main effective indicators were vascular recanalization rate and 90-day favorable outcome [90-day modified Rankin Scale score(m RS)≤2].The main safe endpoints were postoperative symptomatic intracranial hemorrhage rate and 90-day mortality.Results: There were 305 patients collected,including 46 patients(15.1%)in the tandem lesions group and 259(84.9%)in the single vascular group.After propensity score matching,there were no significant differences in vascular recanalization rate,90-day m RS and symptomatic intracranial hemorrhage rate between the two groups.In patients with tandem lesions,compared with the non-stent group,the discharge NIHSS score of the stent group was lower [6(3,14)vs 11(8,20),p=0.029],and the 90-day favorable outcome was higher(72.0% vs 47.6%,p=0.091).Choice of recanalization approach(antegrade vs retrograde)in the tandem group made no difference,except for a trend toward shorter time from puncture to recanalization using the retrograde approach[60(42-96)min vs 80(60-120)min,p=0.065].Multivariate logistic regression analysis showed that internal carotid artery(ICA)lesion combined with ICA-terminus embolism was an independent risk factor for the prognosis of patients with tandem lesions(middle cerebral artery vs ICA-terminus OR= 0.100,95%CI 0.016-0.638,p=0.015).Good collateral circulation was associated with better outcome(grade 0 vs grade 2 OR=14.337,95%CI 1.194-172.098,p=0.036).Conclusion: Early EVT is effective and safe for patients with ALVOS,regardless of whether there is severe stenosis or occlusion of the proximal vascular.In the treatment of tandem lesions,early stent implantation may improve the clinical prognosis.The recanalization approach(antegrade and retrograde)can be optimized according to the state of cerebral collateral circulation and the operators’ preference.