Abstract Details

Title Management of Tandem Occlusion Stroke with Endovascular Therapy

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P01 - (-)

Poster/Presentation
Number 230

Objective

Background BACKGROUND: Approximately 25% of patients with middle cerebral artery (MCA) occlusion will have a concomitant ICA occlusion and 50% of patients with an ICA occlusion will have a proximal MCA occlusion. Cervical ICA occlusion with MCA embolic occlusion is associated with a low rate of recanalization and poor outcome after intravenous thrombolysis. We report our experience on acute ischemic stroke patients with TIM occlusion treated with extracranial ICA angioplasty/stenting and intracranial thrombectomy and/or standard intravenous thrombolysis.

Design/Methods DESIGN/METHODS: A retrospective analysis of our stroke database from July 2010 to June 2012 was performed, a total of 9 patients were identified. 6 patients were treated with extracranial ICA angioplasty and intracranial thrombectomy and/or intravenous thrombolysis. Not all patients qualified to receive intravenous t-PA. We examined early neurological improvement (defined by a reduction of National Institutes of Health Stroke Scale (NIHSS) > 8 points). We also evaluated the rate of successful recanalization based on thrombolysis in cerebral infarction (TICI) score of 2b or 3.

Results RESULTS: All treated patients achieved a TICI score of 2b or 3 signifying successful recanalization. In addition, treated patients had an early reduction of their NIHSS by greater than 8 points. None of the untreated patients had an early neurological improvement. Four of the treated patients had a follow up NIHSS at 90 days of 1 or less, mRS at 90 days was 0.

Conclusions CONCLUSIONS: In cases of tandem occlusions of ICA and MCA, multimodal therapy consistent of intravenous thrombolysis and/or extracranial ICA stenting and intracranial thrombectomy to achieve recanalization may be a safe and efficacious therapeutic option for recanalization. Further prospective studies are warranted.

Authors/Disclosures
Waldo Guerrero, MD PRESENTER	Dr. Guerrero has nothing to disclose.
Sarah Naoshy	No disclosure on file
Haitham Dababneh, MD	No disclosure on file
J Mocco	No disclosure on file
	No disclosure on file
Michael F. Waters, MD, PhD, FAAN (Mount Sinai Scholl of Medicine)	Dr. Waters has nothing to disclose.

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