| Endovascular Treatment of Tandem Extracranial/Intracranial Anterior Circulation Occlusions: Preliminary Single-Center Experience. | |
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MedLine Citation:
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PMID: 21512175 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND AND PURPOSE: Acute ischemic stroke due to tandem occlusions of the extracranial internal carotid artery and intracranial arteries has a poor natural history. We aimed to evaluate our single-center experience with endovascular treatment of this unique stroke population. METHODS: Consecutive patients with tandem occlusions of the internal carotid artery origin and an intracranial artery (ie, internal carotid artery terminus, M1 middle cerebral artery, or M2 middle cerebral artery) were studied retrospectively. Treatment consisted of proximal revascularization with angioplasty and stenting followed by intracranial intervention. Endpoints were recanalization of both extracranial and intracranial vessels (Thrombolysis In Myocardial Ischemia ≥2), parenchymal hematoma, and good clinical outcome (modified Rankin Scale ≤2) at 3 months. RESULTS: We identified 77 patients with tandem occlusions. Recanalization occurred in 58 cases (75.3%) and parenchymal hematoma occurred in 8 cases (10.4%). Distal embolization occurred in 3 cases (3.9%). In 18 of 77 patients (23.4%), distal (ie, intracranial) recanalization was observed after proximal recanalization, obviating the need for distal intervention. Good clinical outcomes were achieved in 32 patients (41.6%). In multivariate analysis, Thrombolysis In Myocardial Ischemia ≥2 recanalization, baseline National Institutes of Health Stroke Scale score, baseline Alberta Stroke Programme Early CT score, and age were significantly associated with good outcome. CONCLUSIONS: Endovascular therapy of tandem occlusions using extracranial internal carotid artery revascularization as the first step is technically feasible, has a high recanalization rate, and results in an acceptable rate of good clinical outcome. Future randomized, prospective studies should clarify the role of this approach. |
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Authors:
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Amer M Malik; Nirav A Vora; Ridwan Lin; Syed F Zaidi; Aitziber Aleu; Brian T Jankowitz; Mouhammad A Jumaa; Vivek K Reddy; Maxim D Hammer; Lawrence R Wechsler; Michael B Horowitz; Tudor G Jovin |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-4-21 |
Journal Detail:
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Title: Stroke; a journal of cerebral circulation Volume: - ISSN: 1524-4628 ISO Abbreviation: - Publication Date: 2011 Apr |
Date Detail:
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Created Date: 2011-4-22 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0235266 Medline TA: Stroke Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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From the UPMC Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA; Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA; the Souers Stroke Institute and Center for Cerebrovascular Disease and Skull Base Surgery, St Louis University, St Louis, MO; and the Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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