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Eur Radiol. 2017 Jan;27(1):247-254. Epub 2016 Apr 16.

Stent-Retriever Thrombectomy for Acute Anterior Ischemic Stroke with Tandem Occlusion: A Systematic Review and Meta-Analysis.

Author information

1
FHU IRIS, Department of Interventional Neuroradiology, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, Bron, France.
2
Université Claude Bernard lyon 1, Lyon, France.
3
Department of Interventional Neuroradiology, Western Galilee Hospital, Nahariyya, Israel.
4
FHU IRIS, Department of Interventional Neuroradiology, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, Bron, France. benjamin.gory@chu-lyon.fr.
5
Université Claude Bernard lyon 1, Lyon, France. benjamin.gory@chu-lyon.fr.
6
Hospices Civils de Lyon, Délégation à la Recherche Clinique et à l'Innovation, Cellule Innovation/UMR-CNRS 5510/MATEIS, Bron, France.
7
Division of Health Sciences, The University of Warwick, Warwick Medical School, Coventry, England.
8
Department of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
9
Fédération Hospitalo-Universitaire d'Anesthésie Réanimation Neurologique, Hôpital Neurologique Pierre Wertheimer, Bron, France.
10
EA PI3 Pathophysiology of injury-induced immunosuppression, Université Claude Bernard Lyon 1, Lyon, France.
11
FHU IRIS, Department of Neurology, Stroke Unit, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Bron, France.

Abstract

OBJECTIVES:

To assess the efficacy and safety profile of stent-retriever thrombectomy (SRT) in acute anterior ischemic stroke patients with tandem occlusion.

MATERIALS AND METHODS:

Using the MEDLINE database, we conducted a systematic review and meta-analysis of all studies that included patients with acute ischemic stroke attributable to tandem occlusion who received treatment with SRT between November 2010 and May 2015.

RESULTS:

The literature search identified 11 previous studies involving a total of 237 subjects out of whom 193 (81.4 %) were treated with acute stent placement for the extracranial internal carotid artery occlusion. Mean initial NIHSS score was 17, and median time from onset to recanalization was 283.5 min. Mean intravenous thrombolysis rate was 63.8 %. In the meta-analysis, the recanalization rate reached 81 % (95 % CI, 73-89). Meta-analysis of clinical outcomes showed a pooled estimate of 44 % (95 % CI, 33-55; 10 studies) for favourable outcome, 13 % (95 % CI, 8-20; 10 studies) for mortality, and 7 % (95 % CI, 2-13; eight studies) for symptomatic intracranial haemorrhage.

CONCLUSION:

SRT with emergency carotid stenting is associated with acceptable safety and efficacy in acute anterior stroke patients with tandem occlusion compared to natural history. However, the best modality to treat proximal stenosis is based on an individual case basis.

KEY POINTS:

• Stent retriever thrombectomy of tandem occlusion is efficient and safe. • Emergent carotid stenting during thrombectomy increase symptomatic intracranial haemorrhage without impact mortality. • Thrombectomy of tandem anterior circulation occlusion may be the first therapeutic option.

KEYWORDS:

Anterior circulation; Large vessel occlusion; Stent retriever; Stroke; Thrombectomy

PMID:
27085698
DOI:
10.1007/s00330-016-4338-y
[Indexed for MEDLINE]

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