Initial stenotic occlusion of the internal carotid artery (ICA) with intracranial artery occlusion in acute ischemic stroke is associated with high morbidity and can benefit from endovascular therapy. However, the optimal endovascular strategy is unclear. This study aimed to evaluate the feasibility of the "half" anterograde approach and clinical outcome of treated patients. Revascularization validity of the two "half" anterograde approach with (PEARS technique) or without (plain technique) using an embolic prevention device and aspiration was also compared.
Materials and methods:
Data on initial stenotic occlusion of the ICA with intracranial artery occlusion in our prospective stroke registry database between January 2015 and February 2017 were collected. Clinical and angiographic data were retrospectively analyzed. Clinical outcome was evaluated at 3 months (mRS), defined as an mRS ≤2 as a good clinical outcome.
Overall, 26 patients with tandem occlusion were included, 96.3% of patients had successful recanalization. The rate of a good clinical outcome was 61.8%, symptomatic parenchymal hemorrhage was 7.7%, and mortality was 15.4%. The PEARS technique took less time (56±14 versus 97±31 min, P=0.002) and had less embolic events (0% versus 30.8%, P=0.012) compared with the plain technique. Use of the PEARS technique was an independent predictor for shortening revascularization time (β =-0.651, P=0.001).
The half anterograde approach technique is feasible and safe for treating tandem occlusion. Furthermore, the PEARS technique is associated with a shorter reperfusion time and less embolic events than the plain technique, and should be recommended in tandem occlusion.