Impact of intravenous thrombolysis and emergent carotid stenting on reperfusion and clinical outcomes in patients with acute stroke with tandem lesion treated with thrombectomy: a collaborative pooled analysis

Background and purpose Tandem anterior circulation lesions in the setting of acute ischemic stroke ( AIS ) are a complex endovascular situation that has not been specifically addressed in trials. We determined the predictors of successful reperfusion and good clinical outcome at 90 days after mechanical thrombectomy ( MT ) in patients with AIS with tandem lesions in a pooled collaborative study. Methods This was a retrospective analysis of consecutive patients presenting to 18 comprehensive stroke centers with AIS due to tandem lesion of the anterior circulation who underwent MT . Results A total of 395 patients were included. Successful reperfusion (modified thrombolysis in cerebral infarction score 2b–3) was achieved in 76.7%. At 90 days, 52.2% achieved a good outcome (modified Rankin Scale score 0–2), 13.8% suffered a parenchymal hematoma and 13.2% were dead. Lower National Institutes of Health Stroke Scale score [odds ratio ( OR ), 1.26; 95% confidence intervals ( CI ), 1.07–1.48, P = 0.004], Alberta Stroke Program Early CT Score ≥7 ( OR , 2.00; 95% CI , 1.07–3.43, P = 0.011), intravenous thrombolysis ( OR , 1.47; 95% CI , 1.01–2.12, P = 0.042) and stenting of the extracranial carotid lesion ( OR , 1.63; 95% CI , 1.04–2;53, P = 0.030) were independently associated with successful reperfusion. Lower age ( OR , 1.58; 95% CI , 1.26–1.97, P < 0.001), absence of hypercholesterolemia ( OR , 1.77; 95% CI , 1.10–2.84, P = 0.018), lower National Institutes of Health Stroke Scale scores ( OR , 2.04; 95% CI , 1.53–2.72, P < 0.001), Alberta Stroke Program Early CT Score ≥7 ( OR , 2.75; 95% CI , 1.24–6.10, P = 0.013) and proximal middle cerebral artery occlusion ( OR , 1.59; 95% CI , 1.03–2.44, P = 0.035) independently predicted a good 90‐day outcome. Conclusions Intravenous thrombolysis and emergent stenting of the extracranial carotid lesion were predictors of a successful reperfusion after MT of patients with AIS with tandem lesion of the anterior circulation.