Hybrid interventions for tandem occlusions in acute phase of ischemic stroke

Perehodov S.N.; Gorbenko M.Yu.; Sniczar’ A.V.; Zelenin D.A.; Varfalomeev S.I.; Novikov E.A.; Voronin A.P.; Pankratov A.A.

doi:https://doi.org/10.17116/hirurgia202211113

Perehodov S.N.

City Clinical Hospital named after V.P. Demihov of the Moscow City Health Department

Gorbenko M.Yu.

Demikhov Moscow City Clinical Hospital

Sniczar’ A.V.

V.P. Demihov City Clinical Hospital of the Moscow City Health Department

Zelenin D.A.

City Clinical Hospital named after V.P. Demihov of the Moscow City Health Department

Varfalomeev S.I.

V.P. Demihov City Clinical Hospital of the Moscow City Health Department

Novikov E.A.

Demikhov Moscow City Clinical Hospital

Voronin A.P.

Demikhov Moscow City Clinical Hospital

Pankratov A.A.

Moscow State University of Medicine and Dentistry named after A.I. Evdokimov;
City Clinical Hospital named after V.P. Demihov of the Moscow City Health Department

Hybrid interventions for tandem occlusions in acute phase of ischemic stroke

Authors:

Perehodov S.N., Gorbenko M.Yu., Sniczar’ A.V., Zelenin D.A., Varfalomeev S.I., Novikov E.A., Voronin A.P., Pankratov A.A.

More about the authors

Journal: Pirogov Russian Journal of Surgery. 2022;(11): 13‑22

DOI: 10.17116/hirurgia202211113

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To cite this article:

Perehodov SN, Gorbenko MYu, Sniczar’ AV, et al. Hybrid interventions for tandem occlusions in acute phase of ischemic stroke. Pirogov Russian Journal of Surgery. 2022;(11):13‑22. (In Russ.)
https://doi.org/10.17116/hirurgia202211113

Подписка 2026 Хирургия. Журнал им. Н.И. Пирогова (Pirogov Russian Journal of Surgery)

Использование инфографики авторами научных работ

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OBJECTIVE

To evaluate the effectiveness of hybrid interventions, i.e. endovascular mechanical thrombectomy from intracranial arteries combined with open thrombectomy or carotid endarterectomy from extracranial internal carotid artery.

MATERIAL AND METHODS

We analyzed 16 patients who underwent mechanical thrombectomy/thrombaspiration combined with open surgery between January 2014 and March 2021. All patients had occlusion of extracranial and intracranial segments internal carotid artery or initial segments of the middle cerebral artery. Baseline data, diagnostic algorithm, timing and results of treatment were analyzed. Study endpoints were technical success of revascularization, clinically significant hemorrhagic transformation, NIHSS and modified Rankin score of neurological impairment, as well as outcome of disease within 90 days.

RESULTS

We restored patency of ICA and intracranial arteries in 13 out of 16 patients. In 9 patients, we obtained a positive effect with significant regression of neurological symptoms (mRS <2). In 3 patients, severe neurological deficit persisted throughout the entire follow-up period. Four patients died. Thus, effectiveness of technique was 56.2% (t=3), mortality rate was 25% (t=2.3). There was a relationship between the timing of interventions and outcomes of disease. Indeed, all dead and most of disabled patients underwent surgery later than 6 hours from the onset of disease.

CONCLUSION

Hybrid interventions for tandem occlusions of carotid arteries can significantly increase efficiency and accelerate recanalization of great extracranial vessels in patients with tandem lesions in acute phase of ischemic stroke. Moreover, hybrid interventions significantly reduce the cost of reperfusion procedure. In case of severe atherosclerotic stenosis, simultaneous open endarterectomy from common and internal carotid arteries has a significant advantage over stenting due to no need for antithrombotic therapy.

Keywords:

ischemic stroke

tandem occlusions

hybrid interventions

Authors:

Perehodov S.N.

City Clinical Hospital named after V.P. Demihov of the Moscow City Health Department

Gorbenko M.Yu.

Demikhov Moscow City Clinical Hospital

Sniczar’ A.V.

V.P. Demihov City Clinical Hospital of the Moscow City Health Department

Zelenin D.A.

City Clinical Hospital named after V.P. Demihov of the Moscow City Health Department

Varfalomeev S.I.

V.P. Demihov City Clinical Hospital of the Moscow City Health Department

Novikov E.A.

Demikhov Moscow City Clinical Hospital

Voronin A.P.

Demikhov Moscow City Clinical Hospital

Pankratov A.A.

Moscow State University of Medicine and Dentistry named after A.I. Evdokimov;
City Clinical Hospital named after V.P. Demihov of the Moscow City Health Department

Received:

15.03.2022

Accepted:

12.06.2022

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References:

Kim YS, Garami Z, Mikulik R, Molina CA, Alexandrov AV; CLOTBUST Collaborators. Early recanalization rates and clinical outcomes in patients with tandem internal carotid artery/middle cerebral artery occlusion and isolated middle cerebral artery occlusion. Stroke. 2005;36(4):869-871. https://doi.org/10.1161/01.STR.0000160007.57787.4c
Rubiera M, Ribo M, Delgado-Mederos R, Santamarina E, Delgado P, Montaner J, Alvarez-Sabín J, Molina CA. Tandem internal carotid artery/middle cerebral artery occlusion: an independent predictor of poor outcome after systemic thrombolysis. Stroke. 2006;37(9):2301-2305. https://doi.org/10.1161/01.STR.0000237070.80133.1d
Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, Dávalos A, Majoie CB, van der Lugt A, de Miquel MA, Donnan GA, Roos YB, Bonafe A, Jahan R, Diener HC, van den Berg LA, Levy EI, Berkhemer OA, Pereira VM, Rempel J, Millán M, Davis SM, Roy D, Thornton J, Román LS, Ribó M, Beumer D, Stouch B, Brown S, Campbell BC, van Oostenbrugge RJ, Saver JL, Hill MD, Jovin TG; HERMES collaborators. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723-1731. https://doi.org/10.1016/S0140-6736(16)00163-X
Sivan-Hoffmann R, Gory B, Armoiry X, Goyal M, Riva R, Labeyrie PE, Lukaszewicz AC, Lehot JJ, Derex L, Turjman F. Stent-Retriever Thrombectomy for Acute Anterior Ischemic Stroke with Tandem Occlusion: A Systematic Review and Meta-Analysis. Eur Radiol. 2017;27(1):247-254. https://doi.org/10.1007/s00330-016-4338-y
Lansberg MG, Straka M, Kemp S, Mlynash M, Wechsler LR, Jovin TG, Wilder MJ, Lutsep HL, Czartoski TJ, Bernstein RA, Chang CW, Warach S, Fazekas F, Inoue M, Tipirneni A, Hamilton SA, Zaharchuk G, Marks MP, Bammer R, Albers GW; DEFUSE 2 study investigators. MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2): a prospective cohort study. Lancet Neurol. 2012;11(10):860-867. https://doi.org/10.1016/S1474-4422(12)70203-X
Theron J, Guimaraens L, Coskun O, Sola T, Martin JB, Rufenacht DA. Complications of carotid angioplasty and stenting. Neurosurg Focus. 1998;5(6):4. https://doi.org/10.3171/foc.1998.5.6.7
Diethrich EB, Ndiaye M, Reid DB. Stenting in the carotid artery: initial experience in 110 patients. J Endovasc Surg. 1996;3(1):42-62. https://doi.org/10.1583/1074-6218(1996)003<0042:SITCAI>2.0.CO;2 "> 2.0.CO;2" target="_blank">https://doi.org/10.1583/1074-6218(1996)003<0042:SITCAI>2.0.CO;2
Ederle J, Featherstone RL, Brown MM. Percutaneous transluminal angioplasty and stenting for carotid artery stenosis. Cochrane Database Syst Rev. 2007;(4):CD000515. https://doi.org/10.1002/14651858.CD000515
Wilson MP, Murad MH, Krings T, Pereira VM, O’Kelly C, Rempel J, Hilditch CA, Brinjikji W. Management of tandem occlusions in acute ischemic stroke — intracranial versus extracranial first and extracranial stenting versus angioplasty alone: a systematic review and meta-analysis. J Neurointerv Surg. 2018;10(8):721-728. https://doi.org/10.1136/neurintsurg-2017-013707
Joyce Hellegering, Maarten Uyttenboogaart, Reinoud P H Bokkers, Mostafa El Moumni, Clark J Zeebregts, Maarten J van der Laan Treatment of the extracranial carotid artery in tandem lesions during endovascular treatment of acute ischemic stroke: a systematic review and meta-analysis. Ann Transl Med. 2020;8(19):1278. https://doi.org/10.21037/atm-2020-cass-17
Hasegawa H, Inoue T, Tamura A, Saito I. Emergent intracranial surgical embolectomy in conjunction with carotid endarterectomy for acute internal carotid artery terminus embolic occlusion and tandem occlusion of the cervical carotid artery due to plaque rupture. J Neurosurg. 2015;122(4):939-947. https://doi.org/10.3171/2014.11.JNS132855
Frenkel MB, Renfrow JJ, Singh J, Garg N, Wolfe SQ. Combined interventional and surgical treatment of tandem middle cerebral artery embolus and internal carotid artery occlusion: case report. J Neurosurg. 2018;129(3):718-722. https://doi.org/10.3171/2017.6.JNS162368
Slawski DE, Jumaa MA, Salahuddin H, Shawver J, Humayun MJ, Russell T, Seiwert A, Paolini D, Abbas J, Nazzal M, Tietjen GE, Espinosa-Morales A, Korsnack A, Zaidi SF. Emergent carotid endarterectomy versus stenting in acute stroke patients with tandem occlusion. J Vasc Surg. 2018;68(4):1047-1053. https://doi.org/10.1016/j.jvs.2017.12.077
Zhu F, Hossu G, Soudant M, Richard S, Achit H, Beguinet M, Costalat V, Arquizan C, Consoli A, Lapergue B, Rouchaud A, Macian-Montoro F, Biondi A, Moulin T, Marnat G, Sibon I, Paya C, Vannier S, Cognard C, Viguier A, Mazighi M, Obadia M, Hassen WB, Turc G, Clarençon F, Samson Y, Dumas-Duport B, Preterre C, Barbier C, Boulanger M, Janot K, Annan M, Bricout N, Henon H, Soize S, Moulin S, Labeyrie MA, Reiner P, Pop R, Wolff V, Ognard J, Timsit S, Reyre A, Perot C, Papagiannaki C, Triquenot-Bagan A, Bracard S, Anxionnat R, Derelle AL, Tonnelet R, Liao L, Schmitt E, Planel S, Guillemin F, Gory B. Effect of emergent carotid stenting during endovascular therapy for acute anterior circulation stroke patients with tandem occlusion: A multicenter, randomized, clinical trial (TITAN) protocol. Int J Stroke. 2021;16(3):342-348. https://doi.org/10.1177/1747493020929948.
Shamalov N.A., Khamanova D.R., Stakhovskaya L.V., Voznyuk I.A., Yanishevsky S.N., Vinogradov O.I., Kharitonova T.V., Alekyan B.G., Kandyba D.V., Savello A.V., Volodyukhin M.Yu. Reperfusion therapy for ischemic stroke. Clinical protocount M. 2019;80. (In Russ.).