Direct dotterising or angioplasty of acute stroke due to tandem atherosclerotic occlusions

Area of Science:

• Neurology
• Vascular Surgery
• Interventional Radiology

Background:

• Tandem occlusions account for 10-15% of large vessel occlusion (LVO) acute ischemic strokes.
• These occlusions present treatment challenges and are often excluded from clinical trials.
• The optimal endovascular approach remains under investigation.

Purpose of the Study:

• To compare the efficacy of a direct endovascular technique using a 0.035-inch guidewire versus the standard 0.014-inch guidewire technique for treating atherosclerotic tandem occlusions.
• To evaluate successful recanalization rates, functional outcomes, and procedure times.

Main Methods:

• Retrospective analysis of 42 patients with atherosclerotic tandem occlusions across three centers.
• Comparison between a direct technique (0.035-inch guidewire with dotterisation or peripheral balloon angioplasty) and the standard technique (0.014-inch guidewire).
• Assessment of modified Treatment in Cerebral Infarction (mTICI) scores, modified Rankin Scale (mRS) scores at 90 days, and puncture-to-recanalization times.

Main Results:

• The direct 0.035-inch guidewire technique achieved significantly higher successful recanalization rates (100% vs. 72%, P=0.018).
• Improved 90-day functional outcomes (mRS 0-2) were observed in the direct technique group (88.4% vs. 48.0%, P=0.044).
• Procedure times were substantially reduced with the direct technique (mean 65.1 min vs. 114.8 min, P<0.001) with similar complication rates.

Conclusions:

• The direct endovascular technique using 0.035-inch guidewires and dotterisation or a peripheral vascular balloon is a faster and more effective method for treating atherosclerotic tandem occlusions.
• This approach offers superior procedural efficiency and patient outcomes compared to previous techniques.
• Further external validation in larger patient cohorts is warranted to confirm these findings.