Clinical Outcomes and Predictive Factors in Acute Tandem Occlusion: A Single-Center Experience

Ritthikrai  Wichianrat; Boonrerk Sangpetngam; Thaweesak Aurboonyawat; Ekawut Chankaew; Anchalee Churojana; Pattarawit  Withayasuk

doi:10.33192/smj.v78i5.278546

Authors

Ritthikrai Wichianrat Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Boonrerk Sangpetngam Siriraj Center of Interventional Radiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Thaweesak Aurboonyawat Siriraj Center of Interventional Radiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Ekawut Chankaew Siriraj Center of Interventional Radiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Anchalee Churojana Siriraj Center of Interventional Radiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Pattarawit Withayasuk Siriraj Center of Interventional Radiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand; Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand

DOI:

https://doi.org/10.33192/smj.v78i5.278546

Keywords:

Tandem occlusion, Mechanical thrombectomy, Acute ischemic stroke, Carotid stenting, Clinical outcome, Predictive factors

Abstract

Objective: To evaluate treatment outcomes and analyze predictive factors associated with favorable outcomes in patients with acute tandem occlusion (TO) stroke who underwent mechanical thrombectomy (MT) at a single, high-volume center.

Materials and Methods: This retrospective study analyzed patients with anterior circulation stroke who underwent MT between January 2010 and December 2023. Ninety-two patients with TO, defined as severe stenosis (>70%) or occlusion of the cervical internal carotid artery (c-ICA) with concurrent intracranial occlusion, were identified. The primary endpoint was a favorable functional outcome (modified Rankin Scale [mRS] 0–2) at 90 days. Multivariate logistic regression was performed to identify independent predictors.

Results: Of 743 anterior circulation patients (651 single occlusion [SO], 92 TO [12.4%]), favorable outcomes were achieved in 55.4% of TO patients with a mortality rate of 9.8%, not significantly different from SO (58.0% favorable, 7.9% mortality; p=0.67) in unadjusted comparison. Multivariate analysis identified three independent predictors of favorable outcomes: age ≤65 years (OR 5.2, 95% CI 1.6–16.5, p=0.005), initial NIHSS ≤16 (OR 3.9, 95% CI 1.2–12.5, p=0.022), and successful recanalization (mTICI ≥2b) (OR 6.5, 95% CI 1.1–39.9, p=0.043).

Conclusion: MT for acute TO yields outcomes comparable to SO in unadjusted analysis. Age ≤65 years, lower initial NIHSS, and successful recanalization are key predictors of favorable outcomes. Acute carotid stenting showed a trend toward better functional outcomes but was associated with higher hemorrhage rates; definitive conclusions require further investigation.

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