ArticleAJNR. American journal of neuroradiology2025
Effects of Emergent Carotid Stenting Performed before or after Mechanical Thrombectomy in the Endovascular Management of Patients with Tandem Lesions: A Multicenter Retrospective Matched Analysis.
Article in AJNR. American journal of neuroradiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Endovascular management of tandem occlusions: current evidence and future directions.Journal of neurointerventional surgery · 2026Review
- Microcatheter delivery of embolic protection devices for acute atherosclerotic tandem occlusion: patient series.Journal of neurosurgery. Case lessons · 2025Article
- Navigating severe vascular tortuosity and cervical carotid loop management in stroke thrombectomy: A case report and review of the literature.Journal of cerebrovascular and endovascular neurosurgery · 2025Article
- Mechanical thrombectomy failure in anterior and posterior circulation stroke: current results from a high-volume comprehensive center.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025Article
- Platelet-Function-Monitoring-Guided Therapy After Emergent Carotid Artery Stenting.Journal of clinical medicine · 2024Article
- Treatment outcomes of antegrade versus retrograde approaches in tandem occlusion: a single-center retrospective study from Vietnam.Frontiers in neurologyArticle
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26 authors.
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Abstract
background and purposeMechanical thrombectomy (MT) along with emergent carotid stent placement (eCAS) has been suggested to have a greater benefit in patients with tandem lesions (TL), compared with other strategies of treatment. Nonetheless, there is no agreement on whether the intracranial occlusion should be treated before the cervical ICA lesion, or vice versa. In this retrospective multicenter study, we sought to compare clinical and procedural outcomes of the 2 different treatment approaches in patients with TL. MATERIALS AND
methodsThe prospective databases of 17 comprehensive stroke centers were screened for consecutive patients with TL who received MT and eCAS. Patients were divided in 2 groups based on whether they received MT before eCAS (MT-first approach) or eCAS before MT (eCAS-first approach). Propensity score matching was used to estimate the effect of the retrograde-versus-anterograde approach on procedure-related and clinical outcome measures. These included the modified TICI score 2b-3, other procedure-related parameters and adverse events after the endovascular procedure, and the ordinal distribution of the 90-day mRS scores.
resultsA total of 295 consecutive patients were initially enrolled. Among them, 208 (70%) received MT before eCAS. After propensity score matching, 56 pairs of patients were available for analysis. In the matched population, the MT-first approach resulted in a higher rate of successful intracranial recanalization (91% versus 73% in the eCAS-first approach,
conclusionsOur study demonstrates that in patients with TL undergoing endovascular treatment, prioritizing the intracranial occlusion is associated with an increased rate of efficient MT and faster recanalization time. However, this strategy does not have an advantage in long-term clinical outcome. Future controlled studies are needed to determine the optimal treatment technique.
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