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SNIS 20th annual meeting electronic poster abstracts
E-125 Clinical outcomes of mechanical thrombectomy in posterior circulation tandem occlusions: multicenter experience
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  1. M Salem1,
  2. G Sioutas1,
  3. M Mohammaden2,
  4. A Luisa Kuhn3,
  5. A Luisa Kuhn3,
  6. A Luisa Kuhn3,
  7. C Tschoe4,
  8. M Tarek5,
  9. A Dmytriw6,
  10. R Regenhardt6,
  11. S Marioni7,
  12. M AbdalKader8,
  13. G Cortez9,
  14. V Srinivasan1,
  15. T Nguyen8,
  16. S Tjoumakaris10,
  17. A Puri11,
  18. V Pereira12,
  19. J Rabinov12,
  20. J Seigler13,
  21. R Hanel9,
  22. S Sheth7,
  23. A Siddiqui14,
  24. E Levy14,
  25. D Haussen2,
  26. M Lang15,
  27. M Lang15,
  28. P Kan16,
  29. O Tanweer17,
  30. B Gross15,
  31. B Gross15,
  32. A Thomas18,
  33. T Jovin13,
  34. R Nogueira2,
  35. P Jabbour10,
  36. B Jankowitz1,
  37. J Burkhardt1
  1. 1Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
  2. 2Neurosurgery, Grady Memorial Hospital, Atlanta, GA, USA
  3. 3University of Massachusetts, Worcester, MA, USA
  4. 4Baylor College of Medicine, Houston, TX, USA
  5. 5Grady Memorial Hospital, Atlanta, GA, USA
  6. 6Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
  7. 7Neurosurgery, University of Houston, Houston, TX, USA
  8. 8Neurosurgery, Boston Medical Center, Boston, MA, USA
  9. 9Neurosurgery, Baptist Neurological Institute, Jacksonville, FL, USA
  10. 10Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
  11. 11Neurosurgery, University of Massachusetts, Worcester, MA, USA
  12. 12Neurosurgery, University of Toronto, Toronto, ON, Canada
  13. 13Neurosurgery, Cooper University Hospital, Camden, NJ, USA
  14. 14Neurosurgery, University of buffalo, Buffalo, NY, USA
  15. 15Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
  16. 16Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA
  17. 17Neurosurgery, Baylor College of Medicine, Texas, TX, USA
  18. 18Neurosurgery, Cooper University Hospital, Camden, MA, USA

Abstract

Introduction Scarce amount of data currently exist regarding mechanical thrombectomy (MT) outcomes in posterior circulation tandem occlusions, with most available data limited to small single-center series.

Methods Series of consecutive patients undergoing MT for tandem posterior occlusions from 15 North-American centers (2016-2022) were included. Inclusion criteria were patients with posterior circulation stroke due to intracranial VA, BA, or PCA occlusion (distal lesion), with tandem occlusion defined as stenosis/occlusion of the extracranial VA with the resultant impaired flow (proximal lesion) rendering potential treatment. The primary radiological outcome was successful recanalization defined as mTICI score of ≥2b, with the clinical endpoint of MT safety and functional outcomes utilizing a modified Rankin Scale (mRS) at 90-days/last available follow-up.

Results 138 patients were included (mean age 63±15 years, 35.4% females). The median initial NIHSS score was 17 (IQR 9.5-28); pre-procedural intravenous thrombolytic therapy was utilized in 29% of patients (92.5% received tPA), with 77.5% of procedures utilizing general anesthesia. The most used first-line MT technique included stand-alone aspiration catheters in 36.2% of the cases followed by a combination of SR+ADAPT in 29.7%, and eventual rescue stenting in 42.8% of cases. The median time from last-known-well to puncture time was 6 hours (IQR 3.8-13.2), with a median time from puncture-to-recanalization of 52 minutes (IQR 32-93). For distal lesions, a mean number of passes was 1.5±1.2, while for proximal lesions, endovascular revascularization was performed in 76.1% of cases, with a mean number of 1.3±0.8 of passes. Successful revascularization occurred in 88.4% of procedures. In terms of periprocedural complications, dissection occurred in 2.9%, vessel perforation 4.8%, and immediate vessel re-occlusion in 2.9% (requiring rescue stenting). Post-procedural symptomatic intracerebral hemorrhage occurred in 8% of the cases. Favorable clinical outcomes (90-day mRS 0-3) occurred in 44.2% of the patients, with a 32.6% mortality rate.

Conclusion Mechanical thrombectomy for posterior circulation tandem occlusions is feasible with reasonable clinical outcomes, despite a high rate of rescue stenting.

Disclosures M. Salem: None. G. Sioutas: None. M. Mohammaden: None. A. Luisa Kuhn: None. A. Luisa Kuhn: None. A. Luisa Kuhn: None. C. Tschoe: None. M. Tarek: None. A. Dmytriw: None. R. Regenhardt: None. S. Marioni: None. M. AbdalKader: None. G. Cortez: None. V. Srinivasan: None. T. Nguyen: None. S. Tjoumakaris: None. A. Puri: None. V. Pereira: None. J. Rabinov: None. J. Seigler: None. R. Hanel: None. S. Sheth: None. A. Siddiqui: None. E. Levy: None. D. Haussen: None. M. Lang: None. M. Lang: None. P. Kan: None. O. Tanweer: None. B. Gross: None. B. Gross: None. A. Thomas: None. T. Jovin: None. R. Nogueira: None. P. Jabbour: None. B. Jankowitz: None. J. Burkhardt: None.

https://doi.org/10.1136/jnis-2023-SNIS.225

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