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Endovascular treatment for acute ischemic stroke in patients with tandem lesion in the anterior circulation: analysis from the METRICS study
  1. Daniel Sanak1,
  2. Martin Kocher2,
  3. Jana Zapletalova3,
  4. Filip Cihlar4,
  5. Daniel Czerny5,
  6. David Cernik6,
  7. Petr Duras7,
  8. Jan Fiksa8,
  9. Jakub Husty9,
  10. Lubomir Jurak10,
  11. Martin Kovar11,
  12. Jiri Lacman12,
  13. Radek Padr13,
  14. Pavel Prochazka14,
  15. Jan Raupach15,
  16. Martin Reiser16,
  17. Vladimir Rohan17,
  18. Martin Roubec18,
  19. Jindrich Sova19,
  20. Miroslav Sercl20,
  21. Miroslav Skorna21,
  22. Libor Simunek22,
  23. Alena Snajdrova23,
  24. Martin Sramek24,
  25. Ales Tomek25
  1. 1Department of Neurology, Palacký University Faculty of Medicine and University Hospital Olomouc, Olomouc, Czech Republic
  2. 2Department of Radiology, Palacký University Faculty of Medicine and University Hospital Olomouc, Olomouc, Czech Republic
  3. 3Department of Biophysics and Statistics, Palacky University Olomouc, Olomouc, Czech Republic
  4. 4Department of Radiology, Masaryk Hospital in Usti nad Labem, Usti nad Labem, Czech Republic
  5. 5Department of Radiology, University Hospital Ostrava, Ostrava, Czech Republic
  6. 6Department of Neurology, Krajska zdravotni as Masarykova nemocnice v Usti nad Labem oz, Usti nad Labem, Czech Republic
  7. 7Department of Radiology, University Hospital Plzen, Plzen, Czech Republic
  8. 8Department of Neurology, General University Hospital in Prague, Prague, Czech Republic
  9. 9Department of Radiology and Nuclear Medicine, University Hospital Brno, Brno, Czech Republic
  10. 10Department of Neurology, Regional Hospital Liberec, Liberec, Czech Republic
  11. 11Department of Neurology, Na Homolce Hospital, Prague, Czech Republic
  12. 12Department of Radiology, Central Military Hospital Prague, Prague, Czech Republic
  13. 13Department of Radiology, University Hospital Motol Prague, Prague, Czech Republic
  14. 142nd Department of Internal Medicine, General University Hospital in Prague, Prague, Czech Republic
  15. 15Department of Radiology, Charles University Faculty of Medicine and University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
  16. 16Department of Neurology, Regional Hospital Ceske Budejovice, Ceske Budejovice, Czech Republic
  17. 17Department of Neurology, Charles University Faculty of Medicine and University Hospital Plzen, Plzen, Czech Republic
  18. 18Department of Neurology, University of Ostrava Faculty of Medicine and University Hospital Ostrava, Ostrava, Czech Republic
  19. 19Department of Radiology, Regional Hospital Ceske Budejovice, Ceske Budejovice, Czech Republic
  20. 20Department of Radiology, Regional Hospital Liberec, Liberec, Czech Republic
  21. 21Department of Neurology, Masaryk University Faculty of Medicine and University Hospital Brno, Brno, Czech Republic
  22. 22Department of Neurology, Charles University Faculty of Medicine and University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
  23. 23Department of Radiology, Na Homolce Hospital Prague, Prague, Czech Republic
  24. 24Department of Neurology, Central Military Hospital Prague, Prague, Czech Republic
  25. 25Department of Neurology, Motol University Hospital, Praha, Praha, Czech Republic
  1. Correspondence to Professor Martin Kocher, Department of Radiology, Fakultni nemocnice Olomouc, Olomouc, Olomoucký, Czech Republic; martin.kocher{at}seznam.cz

Abstract

Background Acute ischemic stroke (AIS) due to anterior circulation tandem lesion (TL) remains a technical and clinical challenge for endovascular treatment (EVT). Conflicting results from observational studies and missing evidence from the randomized trials led us to report a recent real-world multicenter clinical experience and evaluate possible predictors of good outcome after EVT.

Methods We analyzed all AIS patients with TL enrolled in the prospective national study METRICS (Mechanical Thrombectomy Quality Indicators Study in Czech Stroke Centers). A good 3-month clinical outcome was scored as 0–2 points in modified Rankin Scale (mRS), achieved recanalization using the Thrombolysis In Cerebral Infarction (TICI) scale and symptomatic intracerebral hemorrhage (sICH) according to the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) criteria.

Results Of 1178 patients enrolled in METRICS, 194 (19.2%) (59.8% males, mean age 68.7±11.5 years) were treated for TL. They did not differ in mRS 0–2 (48.7% vs 46.7%; p=0.616), mortality (17.3% vs 22.7%; p=0.103) and sICH (4.7% vs 5.1%; p=0.809) from those with single occlusion (SO). More TL patients with prior intravenous thrombolysis (IVT) reached TICI 3 (70.3% vs 50.8%; p=0.012) and mRS 0–2 (55.4% vs 34.4%; p=0.007) than those without IVT. No difference was found in the rate of sICH (6.2% vs 1.6%; p=0.276). Multivariate logistic regression analysis showed prior IVT as a predictor of mRS 0–2 after adjustment for potential confounders (OR 3.818, 95% CI 1.614 to 9.030, p=0.002).

Conclusion Patients with TL did not differ from those with SO in outcomes after EVT. TL patients with prior IVT had more complete recanalization and mRS 0–2 and IVT was found to be a predictor of good outcome after EVT.

  • Stroke
  • Thrombectomy
  • Stent

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Contributors DS, MK: Substantial contributions to the conception and design of the work, data acquisition, analysis and interpretation of data for the work, drafting the work and revising it critically for important intellectual content, final approval of the version to be published. JZ: statistical analysis and interpretation of data for the work, revising the work critically for important intellectual content, final approval of the version to be published, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. FC, DC, DČ, PD, JF, JH, LJ, MKř, JL, RP, PP, JR, MR, VR, MR, JS, MŠ, MŠk, LŠ, AŠ, MŠr, AT: data acquisition, revising the work critically for important intellectual content, final approval of the version to be published, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. DS is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.