PT  - JOURNAL ARTICLE
AU  - Cynthia B Zevallos
AU  - Mudassir Farooqui
AU  - Darko Quispe-Orozco
AU  - Alan Mendez-Ruiz
AU  - Mary Patterson
AU  - Kristine Below
AU  - Sheila O Martins
AU  - Ossama Y Mansour
AU  - Francisco Mont’Alverne
AU  - Thanh N Nguyen
AU  - Luis Lemme
AU  - Adnan H Siddiqui
AU  - Justin F Fraser
AU  - Ashutosh P Jadhav
AU  - Osama O Zaidat
AU  - Santiago Ortega-Gutierrez
TI  - Proximal Internal Carotid artery Acute Stroke Secondary to tandem Occlusions (PICASSO) international survey
AID  - 10.1136/neurintsurg-2020-017025
DP  - 2021 Dec 01
TA  - Journal of NeuroInterventional Surgery
PG  - 1106--1110
VI  - 13
IP  - 12
4099  - http://jnis.bmj.com/content/13/12/1106.short
4100  - http://jnis.bmj.com/content/13/12/1106.full
SO  - J NeuroIntervent Surg2021 Dec 01; 13
AB  - Background While mechanical thrombectomy (MT) is the standard of care for large vessel occlusion strokes, the optimal management of tandem occlusions (TO) remains uncertain. We aimed to determine the current practice patterns among stroke physicians involved in the treatment of TO during MT.Methods We distributed an online survey to neurovascular practitioners (stroke neurologists, neurointerventionalists, neurosurgeons, and radiologists), members of professional societies. After 2 months the site was closed and data were extracted and analyzed. We divided respondents into acute stenting and delayed treatment groups and responses were compared between the two groups.Results We received 220 responses from North America (48%), Latin America (28%), Asia (15%), Europe (5%), and Africa (4%). Preferred timing for cervical revascularization varied among respondents; 51% preferred treatment in a subsequent procedure during the same hospitalization whereas 39% preferred to treat during MT. Angioplasty and stenting (41%) was the preferred technique, followed by balloon angioplasty and local aspiration (38%). The risk of intracerebral hemorrhage was the most compelling reason for not stenting acutely (68%). There were no significant differences among practice characteristics and timing groups. Most practitioners (70%) agreed that there is equipoise regarding the optimal endovascular treatment of cervical lesions in TO; hence, 77% would participate in a randomized controlled trial.Conclusions The PICASSO survey demonstrates multiple areas of uncertainty regarding the medical and endovascular management of TOs. Experts acknowledged the need for further evidence and their willingness to participate in a randomized controlled trial to evaluate the best treatment for the cervical TO lesion.Data are available upon reasonable request to the corresponding author.