Endovascular treatment for acute ischemic stroke due to the anterior circulation tandem occlusion

Abstract

Objective To investigate the availability and safety of distal mechanical embolization combined with simultaneous carotid stenting for acute ischemic stroke due to anterior circulation tandem occlusion of large intracranial vessels and carotid artery. Methods Ten patients with anterior circulation intracranial artery occlusion combined with severe stenosis or occlusion at the beginning of ipsilateral internal carotid artery were selected in Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University from January to December 2019. All patients were treated with balloon dilation for the lesion at the beginning of the artery. The distal end of the catheter was removed through the guide catheter, and then the carotid stent implantation was performed. Immediately after surgery, modified Thrombolytic in Cerebral Infarction (mTICI) was used to evaluate vascular recanalization. The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the degree of neurological deficit 24 h after surgery, and the modified Rankin Scale (mRS) was used to evaluate the prognosis of 90 d after surgery, and recorded symptomatic intracranial hemorrhage, non⁃symptomatic intracranial hemorrhage, and surgical complications. Results All patients completed the surgery. The immediate postoperative intracranial vessel mTICI was 2b grade in 5 cases, 3 grade in 3 cases, 2a grade in one case, and 0 grade in one case. The revascularization rate was 8/10. Of the 8 patients with successful revascularization, one patient (12.50%) occurred reocclusion the extracranial segment of the internal carotid artery at 7 d after surgery, but the clinical symptoms were not worsen. Six patients had a NIHSS score ≥ 4 points which were lower than baseline 24 h after surgery, and their symptoms improved significantly; 90 d postoperative mRS score was 0 in 2 cases, 1 in one case, 2 in one case, 3 in 4 cases, 4 in one case, and 6 in one case (died). The rate of good was 4/10. Four cases presented non ⁃ symptomatic intracranial hemorrhage. No symptomatic intracranial hemorrhage and other complications occurred. Conclusions Distal embolization combined with simultaneous carotid stenting is a feasible strategy for acute ischemic stroke due to anterior circulation tandem occlusion.

DOI:10.3969/j.issn.1672⁃6731.2020.11.011