학술논문
Abstract Number ‐ 181: Anterograde versus Retrograde approaches in the Endovascular Management of Tandem Lesions
Document Type
article
Author
Cynthia B Zevallos; Milagros Galecio‐Castillo; Mudassir Farooqui; Michael Abraham; Afshin Divani; Marc Ribo; Nils Petersen; Johanna Fifi; Waldo Guerrero; Amer Malik; James Siegler; Thanh N Nguyen; Sunil A Sheth; Albert J Yoo; Guillermo Linares; Nazli Janjua; Darko Quispe‐Orozco; Wondewossen Tekle; Marion Oliver; Syed Zaidi; Alicia Castonguay; Jessica Kobsa; Ayush Prasad; Asad Ikram; Hamza Answer; Mary Patterson; Manuel Requena; Marta Olive; Abid Qureshi; Tiffany Barkley; Stavros Matsoukas; Ameena Rana; Mohamad Abdalkader; Sergio Salazar‐Marioni; Jazba Soomro; Juan Vivanco‐Suarez; Aaron Rodriguez‐Calientes; Charoskhon Turabova; Randall Edgell; Maxim Mokin; Dileep Yavagal; Osama Zaidat; Mouhammad Jumaa; Ameer Hassan; Santiago Ortega‐Gutierrez
Source
Stroke: Vascular and Interventional Neurology, Vol 3, Iss S1 (2023)
Subject
Language
English
ISSN
2694-5746
Abstract
Introduction There are two approaches for treating stroke patients with tandem occlusions: the anterograde approach (AA, extracranial lesions first) and the retrograde approach (RA, intracranial lesion first). Both techniques are associated with favorable functional outcomes. We aimed to compare both techniques for efficacy and safety outcomes in a multicenter study. Methods Patient data were pooled from 17 centers and divided into AA and RA groups. We performed multivariable logistic regressions to evaluate the association between each group with efficacy and safety outcomes. Results 552 patients were included in the study, 270 (48.4%) were treated with the AA, and 288 (51.6%) with the RA. There were no differences between groups for functional outcome (mRS 0–2) at 90 days (aOR = 0.93, 95%CI: 0.58‐1.48, p = 0.75), and successful reperfusion [mTICI >2b] (aOR = 0.83, 95%CI: 0.44‐1.56, p = 0.57). Similarly, we did not observe any differences for safety outcomes related to sICH (OR = 0.57, 95%CI: 0.25‐1.29, p = 0.18), parenchymal hematoma type 2 (OR = 0.61, 95%CI: 0.3‐1.22, p = 0.16), and all‐cause mortality at 90 days (OR = 1.22, 95%CI: 0.66‐2.26, p = 0.52). However, the median puncture‐to‐reperfusion time was higher in AA compared with RA [59 minutes (IQR: 38–92) vs 53.5 minuntes (IQR: 37–87)]. Conclusions The AA and RA approaches for the treatment of tandem occlusions seem to achieve similar efficacy and safety outcomes. These results are consistent with those of a previous multi‐center study. Additionally, and in line with previous research, there is a puncture‐to‐reperfusion time difference between both approaches, which suggests a potential benefit when using the RA. However, further prospective randomized studies are needed to elucidate its benefit in achieving better clinical outcomes.