Endovascular Treatment of Patients with Acute Ischemic Stroke Caused by Tandem Lesions of the internal Carotid Artery

The incidence of tandem internal carotid artery (ICA) lesions, according to various sources, is 15–30% of all ischemic strokes (IS) caused by occlusion of a large intracranial artery. However, due to the lack of randomized clinical trials, the optimal revascularization strategy in this cohort of patients remains uncertain and requires further study.

AIM OF THE STUDY. The aim of this study is to investigate the efficacy and safety of different endovascular approaches to the treatment of patients with acute ischemic stroke caused by tandem ICA lesions.

MATERIAL AND METHODS. The study included 94 patients with acute ischemic stroke caused by tandem ICA lesions. After successful intracranial reperfusion (mTICI 2b-3), all patients were divided into two groups. In the study group (48 patients), after achieving successful intracranial reperfusion, patients were implanted with a stent in the area of the lesion of the extracranial ICA with the administration of loading doses of dual antiplatelet therapy. In the comparison group (46 patients), after achieving successful intracranial reperfusion, patients were prescribed optimal drug therapy in accordance with current international recommendations, including antiplatelet therapy (in this group, revascularization of the extracranial ICA was considered after achieving a favorable functional outcome; assessed using the modified Rankin scale 0–2). The statistical program Stattech was used to analyze the obtained data.

RESULTS. The frequency of favorable functional outcome after 90 days (mRs 0–2) in the study and comparison groups were 64.6% and 41.3%, respectively (p=0.024), and there was also a statistically significant difference in the frequency of early patency of the extracranial ICA in the study and comparison groups — 89.6% and 67.4%, respectively (p=0.009). The frequency of symptomatic intracerebral hemorrhage in the groups was comparable: 6.2% and 4.3%, respectively (p=1.000). In the comparison group, death was observed more often, but the difference was not statistically significant — 19.6% and 10.4%, respectively (p=0.255). Patients with early patency of the extracranial ICA statistically significantly more often achieved a favorable functional outcome (p=0.019) and statistically significantly less often died within three months (p=0.032).

CONCLUSION. This study showed that intravascular thromboembolectomy from an occluded large intracranial artery in combination with emergency stenting of the internal carotid artery is the most effective endovascular treatment for patients with acute ischemic stroke caused by its tandem lesion.

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