Endovascular treatment for acute tandem occlusion of proximal internal carotid artery and intracranial large artery

Abstract

Objective To evaluate the efficacy and safety of endovascular treatment (EVT) for acute tandem occlusion of proximal internal carotid artery (ICA) and intracranial large artery. Methods Five patients presented with acute tandem occlusion of proximal and intracranial ICA and middle cerebral artery (MCA) presented from August to November 2018 were included. Every patient was treated with proximal ICA stenting first and then intracranial artery sent thrombectomy. The result of revascularization was recorded with Thrombolysis in Cerebral Infarction (TICI) at the end of procedure. The outcome at 3 d, 90 d and one year postprocedure was evaluated with modified Rankin Scale (mRS). Results Proximal ICA stenting was successful and intracranial artery sent thrombectomy was performed in all patients. TICI grade 2b-3 was achieved in 4 patients and TICI grade 2a in one patient immidiately after surgery vascular recanalization rate was 4/5. There was no intracranial hemorrhage and more infarction. All patients had improved significantly. At 90 d after discharge, 2 patients had a mRS score 0, 2 patients had a mRS score 2, one patient had a mRS score 3. After one year, all patients remained a favorable clinical outcome (mRS score 0-1). Conclusions For patients presented with acute tandem occlusion of proximal ICA and intracranial large artery, antegrade recanalization with proximal ICA stenting and intracranial sent thrombectomy are safe and efficacious.DOI：10.3969/j.issn.1672⁃6731.2020.05.008