Stent-Retriever Thrombectomy for Acute Anterior Ischemic Stroke with Tandem Occlusion: A Systematic Review and Meta-Analysis

Objectives To assess the efficacy and safety profile of stent-retriever thrombectomy (SRT) in acute anterior ischemic stroke patients with tandem occlusion. Materials and methods Using the MEDLINE database, we conducted a systematic review and meta-analysis of all studies that included patients with...

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Bibliographic Details
Published in:European radiology 2017, Vol.27 (1), p.247-254
Main Authors: Sivan-Hoffmann, Rotem, Gory, Benjamin, Armoiry, Xavier, Goyal, Mayank, Riva, Roberto, Labeyrie, Paul Emile, Lukaszewicz, Anne-Claire, Lehot, Jean-Jacques, Derex, Laurent, Turjman, Francis
Format: Article
Language:English
Subjects:
Arterial Occlusive Diseases - complications
Arterial Occlusive Diseases - surgery
Carotid arteries
Carotid Artery, Internal - surgery
Carotid Stenosis - complications
Carotid Stenosis - surgery
Device Removal
Diagnostic Radiology
Engineering Sciences
Hemorrhage
Humans
Imaging
Internal Medicine
Interventional Radiology
Ischemia
Materials
Medicine
Medicine & Public Health
Meta-analysis
Middle Cerebral Artery
Mortality
Neuro
Neuroradiology
Radiology
Stents
Stroke
Stroke - etiology
Stroke - surgery
Systematic review
Thrombectomy - methods
Treatment Outcome
Ultrasound
Veins & arteries
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Summary:Objectives To assess the efficacy and safety profile of stent-retriever thrombectomy (SRT) in acute anterior ischemic stroke patients with tandem occlusion. Materials and methods Using the MEDLINE database, we conducted a systematic review and meta-analysis of all studies that included patients with acute ischemic stroke attributable to tandem occlusion who received treatment with SRT between November 2010 and May 2015. Results The literature search identified 11 previous studies involving a total of 237 subjects out of whom 193 (81.4 %) were treated with acute stent placement for the extracranial internal carotid artery occlusion. Mean initial NIHSS score was 17, and median time from onset to recanalization was 283.5 min. Mean intravenous thrombolysis rate was 63.8 %. In the meta-analysis, the recanalization rate reached 81 % (95 % CI, 73–89). Meta-analysis of clinical outcomes showed a pooled estimate of 44 % (95 % CI, 33–55; 10 studies) for favourable outcome, 13 % (95 % CI, 8–20; 10 studies) for mortality, and 7 % (95 % CI, 2–13; eight studies) for symptomatic intracranial haemorrhage. Conclusion SRT with emergency carotid stenting is associated with acceptable safety and efficacy in acute anterior stroke patients with tandem occlusion compared to natural history. However, the best modality to treat proximal stenosis is based on an individual case basis. Key Points • Stent retriever thrombectomy of tandem occlusion is efficient and safe . • Emergent carotid stenting during thrombectomy increase symptomatic intracranial haemorrhage without impact mortality . • Thrombectomy of tandem anterior circulation occlusion may be the first therapeutic option
ISSN:0938-7994
1432-1084
DOI:10.1007/s00330-016-4338-y