Abstract
SUMMARY: Approximately 15% of patients undergoing endovascular thrombectomy for anterior circulation acute ischemic stroke have a tandem lesion, defined as a severe stenosis or occlusion of the cervical internal carotid artery ipsilateral to its intracranial occlusion. Patients with tandem lesions have worse outcomes than patients with isolated intracranial occlusions, but the optimal management of their carotid lesions during endovascular thrombectomy remains controversial. The main options commonly used in current practice include acute stent placement in the carotid lesion versus thrombectomy alone without definitive revascularization of the carotid artery. While treatment decisions for these patients are often complex and strategies vary according to clinical, anatomic, and technical considerations, only results from randomized trials comparing these approaches are likely to strengthen current recommendations and optimize patient care.
ABBREVIATIONS:
- AIS
- acute ischemic stroke
- c-ICA
- cervical internal carotid artery
- EVT
- endovascular thrombectomy
- IVT
- intravenous thrombolysis
- TL
- tandem lesion
Footnotes
Disclosures: Alexandre Y. Poppe—RELATED: Grant: Canadian Stroke Trials for Optimized Results, Comments: networking seed grant for Randomized Trial of Tandem Carotid Lesions (EASI-TOC)*; UNRELATED: Other: Servier Laboratories, Bristol-Myers Squibb–Pfizer, Bayer AG, Comments: Servier Laboratories, institutional support for stroke fellowship; Bristol-Myers Squibb–Pfizer, Bayer AG, institutional support for electronic medical record service; OTHER RELATIONSHIPS: I am the Principal Investigator for a randomized trial studying patients with tandem carotid lesions undergoing endovascular thrombectomy (EASI-TOC, NCT04261478). Daniel Roy—UNRELATED: Payment for Development of Educational Presentations: Radiological Society of Quebec, Comments: payments for production of a workshop on CT angiography. *Money paid to the institution.
- © 2020 by American Journal of Neuroradiology
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