Endovascular Therapy of Tandem Occlusions: Baseline Characteristics and Outcomes Compared With Intracranial Occlusion

Background Endovascular therapy is highly effective in stroke caused by large vessel occlusion. Guidelines support treatment in case of occlusion of the intracranial internal carotid artery or the first segment of the middle cerebral artery. We aimed to examine baseline characteristics and outcome of patients who underwent endovascular therapy for tandem occlusions. Methods We conducted a retrospective study of patients who underwent endovascular therapy of tandem occlusion or occlusion of intracranial internal carotid artery/first segment of the middle cerebral artery between May 2015 and December 2019. Univariate comparisons of baseline characteristics and outcome (favorable functional outcome 90-days after treatment and mortality) were performed. We used inverse-probability-of-treatment-weights to adjust for confounders. Results We compared 167 patients with tandem occlusion and 414 with intracranial occlusions. Patients with tandem occlusion were younger (69 years [interquartile range: 59.25-76] versus 74 [interquartile range: 64-81]; P = 0.0002), male (64.7% versus 51.4%; P = 0.004), more frequently active smokers (42.5% versus 25.6%; P = 0.0001), and less frequently subject to atrial fibrillation (18.6% versus 41.3%; P<0.0001). No significant differences were seen in the rate of 90-day good outcome (49.1% versus 51.0%; P = 0.68) or mortality (16.8% versus 18.1%; P = 0.70). This was also true after adjustment (relative risk for poor outcome 0.86 [95% CI: 0.72-1.05]). More proximal occlusions resulted in worse outcome in both tandem and intracranial occlusions. Conclusion Patients with tandem occlusion were more frequently younger, male smokers without atrial fibrillation illustrating the different risk factors underlying these strokes. Benefit from treatment was similar between groups, supporting endovascular therapy in tandem occlusions.