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 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.
['Sivan-Hoffmann|Rotem|R|', 'Gory|Benjamin|B|', 'Armoiry|Xavier|X|', 'Goyal|Mayank|M|', 'Riva|Roberto|R|', 'Labeyrie|Paul Emile|PE|', 'Lukaszewicz|Anne-Claire|AC|', 'Lehot|Jean-Jacques|JJ|', 'Derex|Laurent|L|', 'Turjman|Francis|F|']
D001157:Arterial Occlusive Diseases D002343:Carotid Artery, Internal D016893:Carotid Stenosis D020878:Device Removal D006801:Humans D020768:Middle Cerebral Artery D015607:Stents D020521:Stroke D017131:Thrombectomy D016896:Treatment Outcome
Thrombectomy Stroke Stent retriever Anterior circulation Large vessel occlusion