Background and aims:
Endovascular management of acute stroke caused by a tandem lesion (TL) in the anterior
circulation is currently a discussed area. Acute insertion of a carotid stent in the absence of
antiaggregation premedication often leads to acute stent occlusion with clinical impact.
Conversely, early anticoagulation or anticoagulant therapy after intravenous thrombolysis can
lead to hemorrhagic complications. The goal of our work is the analysis of different
approaches to the problem in our file.
Methods:
Patients who underwent mechanical thrombectomy (MT) between 2008 and 2022 were
included in a retrospective monocenter study. Neurological deficit was assessed with National
Institutes of Health Stroke Scale (NIHSS), clinical outcome with modified Rankin scale (mRS)
and achieved recanalization using the TICI scale.
Results:
We compared only patients who underwent successful MT (TICI 2b-3). 81 patients had a stent
inserted during MT (58% males, mean age 67.4 ± 8.8 years). A good clinical result (mRS 0-2)
was achieved by 61.7% of patients. Mortality was 17.3%. In 101 patients (48.5% males, mean
age 71.6 ± 12 years) the stent was not inserted and an alternative solution was chosen (retention
of residual stenosis - mainly patients in severe clinical condition, elective stent insertion days
after effective antiaggregation therapy or carotid endarterectomy-CEA). A good clinical result
was achieved by 57.4% of patients. Mortality was 24.8%.
Conclusions:
There was no significant difference in achieving a good clinical outcome between the groups
with acute stenting or with the alternative procedure. Study was supported by grant IGA-KZ-2021-1-15