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Updated: Feb 7, 2026

Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Endovascular management for tandem occlusions of anterior cerebral circulation
Abdelaziz Sagga1, Faris Alebdi, Ibrahim Alnaami
1Department of Neuroscience, the National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.
Objective:
To compare the endovascular approaches and techniques used to treat tandem occlusions of anterior cerebral circulation.
Methods:
A literature review was carried out using PubMed to review the studies that described endovascular therapies for patients with tandem cerebral occlusions.
Results:
A total of 106 patients (median age: 64 years; range: 18-90 years) were identified. The median National Institutes of Health Stroke scale score at the time of admission for 104 patients was 16.5 (standard deviation [SD] +/-5.7). The mean times and ranges from symptom onset to recanalization were 396.85 minutes (range: 120-1,574 minutes) and from groin puncture to recanalization were 80.3 minutes (range: 14-180 minutes). The mean outcome modified Rankin scale (mRS) score was 2.31 (SD +/-2.2), and 61.3% of patients had an outcome mRS score =2. Moreover, 80% of patients with a groin puncture-to-recanalization time of =60 minutes had a mRS score =2 compared to 51.5% of patients with longer times (p=0.02). Despite that only 11.3% of patients underwent a retrograde approach, 81.8% of them had an outcome mRS score =2 compared to 60.8% of patients with an anterograde approach (p=0.023) CONCLUSION: A groin puncture-to-recanalization time of <60 minutes and a retrograde approach were shown to be favorable prognostic factors in terms of mRS score. The use of intravenous tissue plasminogen activator was associated with higher Thrombolysis In Cerebral Infarction scores, but not superior prognosis based on mRS.
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