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Posterior circulation tandem occlusions: Classification and techniques
Journal article   Peer reviewed

Posterior circulation tandem occlusions: Classification and techniques

Joshua H. Weinberg, Ahmad Sweid, Kalyan Sajja, Rawad Abbas, Ashlee Asada, Osman Kozak, Larami Mackenzie, Hana Choe, Michael Reid Gooch, Nabeel Herial, …
Clinical neurology and neurosurgery, v 198, 106154
01 Nov 2020
DOI: https://doi.org/10.1016/j.clineuro.2020.106154
PMID: 32829201
Featured in Collection :   UN Sustainable Development Goals @ Drexel

Abstract

Endovascular Mechanical thrombectomy Neurointervention Posterior circulation Tandem occlusion Vertebrobasilar
• Posterior circulation tandem occlusions are poorly defined and characterized in current literature. • Recanalization is the most important prognostic factor and improves survival with the optimal approach depending on vascular anatomy and occlusive lesions. • Basilar artery recanalization may be technically challenging in the setting of proximal vertebral artery occlusion. • Despite high rates of revascularization (TICI ≥ 2b), posterior circulation tandem occlusions are associated with high rates of morbidity and mortality. • Mechanical thrombectomy is feasible in posterior circulation tandem occlusions with a higher rate of good outcomes compared to other treatment modalities. Posterior circulation tandem occlusions are poorly characterized in current literature. Data regarding endovascular approaches and outcomes in this patient subgroup is extremely limited. We conducted a retrospective analysis of a prospectively maintained database and identified 17 patients with posterior circulation tandem occlusions who underwent mechanical thrombectomy between 2014 and 2019. Of 17 patients with posterior circulation tandem occlusion, the mean age was 55.76 ± 11.8 with 35.3% female. The mean NIHSS score on presentation was 17.2 ± 9.2. Tissue plasminogen activator was administered in 7 (41.2%) patients, stent-retrievers alone were used in 2 (11.8%), aspiration catheters alone were used in 2 (11.8%), a combination was used 12 (70.6%), and a self-expandable stent in 5 (29.4%). The mean number of device passes was 2.24 ± 2.02, recanalization failure occurred in 4 (23.5%) patients, the mean time from stroke onset to puncture was 6.9 ± 2.4 h, and the mean time from puncture to recanalization was 59.3 ± 26.6 min. Postprocedural symptomatic ICH occurred in 1 (5.9 %) patient, periprocedural ICH/SAH occurred in 2 (11.8%), periprocedural distal emboli occurred in 0 (0%), periprocedural vessel dissection occurred in 1 (5.9%), and periprocedural vessel perforation occurred in 1 (5.9%) patient. TICI score>2b was achieved in 13 (76.5%) patients. An improvement in NIHSS>3 at discharge occurred in 10 (58.8%) patients, and good outcomes (mRS score < 2) occurred in 7 (41.2%). The mean length of stay was 11.6 ± 12.2 days, and the mortality rate was 41.2%. Endovascular intervention with mechanical thrombectomy is safe and feasible in patients with posterior circulation tandem occlusions.

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10 citations in Web of Science
9 citations in Scopus

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Domestic collaboration
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Web of Science research areas
Clinical Neurology
Surgery
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