Endovascular treatment strategies for simultaneous bilateral anterior circulation occlusions in acute ischemic stroke: A single-center experience and systematic review of the literature.

IF 2.1 4区 医学 Q3 Medicine
Interventional Neuroradiology Pub Date : 2025-10-01 Epub Date: 2023-05-02 DOI:10.1177/15910199231171806
Gianmarco Bernava, Paul Botti, Andrea Rosi, Jeremy Hofmeister, Hasan Yilmaz, Emmanuel Carrera, Olivier Brina, Philippe Reymond, Michel Muster, Zsolt Kulcsar, Karl-Olof Lovblad, Paolo Machi
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Abstract

BackgroundBilateral and simultaneous occlusion of the anterior circulation is a rare event in patients with acute ischemic stroke. Although endovascular treatment is feasible and safe, the endovascular strategy to be used remains a subject of debate.ObjectiveTo assess the different endovascular strategies proposed for the treatment of a bilateral, simultaneous anterior circulation occlusion following acute ischemic stroke.MethodsWe present a retrospective study of the clinical and radiological records of all patients with a bilateral, simultaneous anterior circulation occlusion treated at our center between January 2019 and December 2022. Following the PRISMA guidelines, we also conducted a systematic review of the literature.ResultsTwo patients with a bilateral and simultaneous middle cerebral artery occlusion were treated at our center during the study period. A TICI score ≥2b was obtained in 4 out of 4 occlusions. Modified Rankin Scale (mRS) at 90 days was 0 and 4, respectively. The literature review retrieved reports on 22 patients. The most frequent bilateral occlusion sites were internal carotid artery-middle cerebral artery. The clinical presentation was severe in most patients. A combined thrombectomy technique proved to have the highest number of first-pass recanalization. A TICI ≥2b was obtained in 95% of patients and an mRS ≤2 was found in 31.8% of patients.ConclusionsIn patients with bilateral and simultaneous occlusion of the anterior circulation, endovascular treatment using a combined technique appears to be rapid and effective. The clinical evolution of this patient population strongly depends on the severity of the onset symptoms.

急性缺血性卒中并发双侧前循环闭塞的血管内治疗策略:单中心经验和文献系统综述。
背景:在急性缺血性脑卒中患者中,双侧和同时的前循环闭塞是一种罕见的事件。虽然血管内治疗是可行和安全的,但血管内治疗策略仍然是一个有争议的话题。目的探讨急性缺血性脑卒中并发双侧前循环闭塞的不同血管内治疗策略。方法回顾性分析2019年1月至2022年12月期间在我中心治疗的所有双侧同时前循环闭塞患者的临床和影像学记录。遵循PRISMA指南,我们还对文献进行了系统的回顾。结果本中心在研究期间治疗了2例双侧和同时发生的大脑中动脉闭塞。4例闭塞患者中有4例TICI评分≥2b。改良Rankin量表(mRS)在90天分别为0和4。文献综述检索了22例患者的报告。双侧最常见的闭塞部位为颈内动脉-大脑中动脉。大多数患者的临床表现都很严重。联合取栓技术被证明具有最高的首通再通次数。95%的患者TICI≥2b, 31.8%的患者mRS≤2。结论对双侧及同时发生的前循环闭塞患者,血管内联合治疗快速有效。该患者群体的临床演变强烈依赖于发病症状的严重程度。
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来源期刊
CiteScore
2.80
自引率
11.80%
发文量
192
审稿时长
6-12 weeks
期刊介绍: Interventional Neuroradiology (INR) is a peer-reviewed clinical practice journal documenting the current state of interventional neuroradiology worldwide. INR publishes original clinical observations, descriptions of new techniques or procedures, case reports, and articles on the ethical and social aspects of related health care. Original research published in INR is related to the practice of interventional neuroradiology...
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