Treatment of acute tandem occlusion of arteries of anterior cerebral circulation without emergency stenting

Logvinenko R.L.^1,2, Kokov L.S.^2,3, Arablinskiy A.V.^4,5

1) Department of Roentgenosurgical Methods of Diagnosis and Treatment, Municipal Clinical Hospital named after V.V. Veresaev of the Moscow Healthcare Department, 2) Department of Radiodiagnosis, I.M. Sechenov First Moscow State Medical University of the RF Ministry of Public Health,
3) Department of Radiodiagnosis, Scientific Research Institute of Emergency Medicine named after N.V. Sklifosovsky of the Moscow Healthcare Department,
4) Department of Roentgenovascular Methods of Diagnosis and Treatment, Municipal Clinical Hospital named after S.P. Botkin of the Moscow Healthcare Department,
5) Chair of Therapy and Adolescent Medicine, Russian Medical Academy of Continuous Professional Education of the RF Ministry of Public Health, Moscow, Russia

The article deals with problems of endovascular treatment of acute tandem and isolated occlusions of arteries of the anterior cerebral circulation, as well as the problem of reocclusions and new occlusions of these target arteries in the early postoperative period after thrombectomy.

Objective. The purpose of this study was to determine the effect of reocclusions and new, previously not identified occlusions of the carotid artery and middle cerebral artery after cerebral thrombectomy on the outcomes of ischaemic stroke, as well as to substantiate feasibility of endovascular policy without simultaneous carotid stenting in thrombectomy in case of tandem occlusions of arteries of the anterior cerebral circulation.

Patients and methods. We studied the results of endovascular treatment of 52 patients with acute ischaemic stroke, including 26 patients with combined occlusions of the internal carotid and middle cerebral arteries (group 1) and 26 patients with isolated occlusion of the M1 segment of the middle cerebral artery or its equivalent (group 2). The groups were compared using the Chi-squared and Mann-Whitney test, and the effect of the factors was assessed by calculating the relative risk.

Results. Disability of patients in group 1 was significantly two-fold higher as compared with group 2. Differences in mortality and frequency of a good functional outcome (0-2 points on the Rankin scale) were, on the contrary, insignificant. Reocclusion of the internal carotid artery demonstrated no significant influence on outcomes of the disease in combined type of the lesion. Reocclusion of the target vessel after thrombectomy significantly decreased the probability of a good functional outcome in patients 1.7-fold (p<0.05), as well as increased the relative risk of disability 4-fold in initially isolated occlusion of the middle cerebral artery (p<0.05).

Conclusions. Surgical policy aimed at thrombectomy from the middle cerebral artery in the presence of tandem occlusions of the internal carotid artery and middle cerebral artery without emergency carotid stenting is safe and efficient in acute period of ischaemic stroke. Reocclusion of the middle cerebral artery after performed thrombectomy related to its isolated occlusion increased the probability of patients’ disability. Newly identified in the postoperative period occlusion of the internal carotid artery in thrombectomy from the middle cerebral artery also increased the risk of disability.

KEY WORDS: cerebral stroke, thrombectomy, tandem occlusion, carotid stenting, reperfusion, surgical policy.

P. 64

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