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

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Abstract

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

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Acknowledgments

The scientific guarantor of this publication is Benjamin Gory, MD, MSc. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Xavier Armoiry kindly provided statistical advice for this manuscript. Institutional Review Board approval was not required because it’s a systematic review. Written informed consent was not required for this study because it’s a systematic review of published articles. Approval from the institutional animal care committee was not required because it’s clinical research. Some study subjects or cohorts have been previously reported in Pubmed database. Methodology: retrospective, observational, multicenter study.

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    Authors and Affiliations

    1. FHU IRIS, Department of Interventional Neuroradiology, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, Bron, France

      Rotem Sivan-Hoffmann, Benjamin Gory, Roberto Riva, Paul Emile Labeyrie & Francis Turjman

    2. Université Claude Bernard lyon 1, Lyon, France

      Rotem Sivan-Hoffmann, Benjamin Gory, Anne-Claire Lukaszewicz, Jean-Jacques Lehot & Francis Turjman

    3. Department of Interventional Neuroradiology, Western Galilee Hospital, Nahariyya, Israel

      Rotem Sivan-Hoffmann

    4. Hospices Civils de Lyon, Délégation à la Recherche Clinique et à l’Innovation, Cellule Innovation/UMR-CNRS 5510/MATEIS, Bron, France

      Xavier Armoiry

    5. Department of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada

      Mayank Goyal

    6. Fédération Hospitalo-Universitaire d’Anesthésie Réanimation Neurologique, Hôpital Neurologique Pierre Wertheimer, Bron, France

      Anne-Claire Lukaszewicz & Jean-Jacques Lehot

    7. EA PI3 Pathophysiology of injury-induced immunosuppression, Université Claude Bernard Lyon 1, Lyon, France

      Anne-Claire Lukaszewicz & Jean-Jacques Lehot

    8. FHU IRIS, Department of Neurology, Stroke Unit, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Bron, France

      Laurent Derex

    9. Division of Health Sciences, The University of Warwick, Warwick Medical School, Coventry, England

      Xavier Armoiry

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    1. Rotem Sivan-Hoffmann
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    Correspondence to Benjamin Gory.

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    Rotem Sivan-Hoffmann and Benjamin Gory contributed equally to this work.

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    Sivan-Hoffmann, R., Gory, B., Armoiry, X. et al. Stent-Retriever Thrombectomy for Acute Anterior Ischemic Stroke with Tandem Occlusion: A Systematic Review and Meta-Analysis. Eur Radiol 27, 247–254 (2017). https://doi.org/10.1007/s00330-016-4338-y

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