Endovascular treatment of tandem lesions: prognostic factors of functional outcome and the efficacy of emergent carotid stenting.

Objective

To investigate the prognostic risk factors for endovascular therapy (EVT) in acute ischemic stroke with tandem lesions, and to evaluate the efficacy and safety of emergent carotid artery stenting.

Methods

Patients with acute internal carotid artery tandem occlusion who underwent endovascular therapy (EVT) were enrolled. Baseline clinical and procedural data were collected. The primary outcome was the 90-day modified Rankin Scale (mRS) score, and the safety endpoint was symptomatic intracerebral hemorrhage (sICH). Propensity score matching (PSM) was applied to balance covariates between patients receiving emergent carotid artery stenting (eCAS) and non-stenting controls. Multivariable binary logistic regression was used to identify independent prognostic factors. Subgroup analyses were conducted on relevant risk factors.

Results

A total of 112 eligible patients were included, with a mean age of 66.19 ± 9.23 years; 76 (67.86%) were male. Fifty-eight patients (51.79%) achieved a favorable functional outcome (good prognosis group). Univariate analysis revealed significant differences (P < 0.05) between the two groups in baseline NIHSS score, ASPECTS score, puncture-to-reperfusion time, history of hypertension, and history of atrial fibrillation. After multivariable adjustment, hypertension, baseline NIHSS score, ASPECTS score, and puncture-to-reperfusion time were identified as independent risk factors for unfavorable 90-day functional outcomes in tandem lesion patients undergoing EVT. Emergent carotid artery stenting (eCAS) was not an independent predictor of 90-day favorable functional outcome (adjusted OR = 0.51, 95% CI 0.17-1.58, P = 0.246). Significant differences in stroke history and smoking history were found between the emergent stenting and non-stenting groups at baseline. Female sex and puncture-to-reperfusion time were independent risk factors for sICH in tandem lesion patients. Subgroup analysis indicated that in those aged ≥ 65 years, emergent stenting was associated with unfavorable 90-day functional prognosis (OR = 0.042, 95% CI 0.004-0.469, P = 0.01).

Conclusion

In this single-center retrospective cohort, hypertension, baseline NIHSS score, ASPECTS score, and puncture-to-reperfusion time may serve as independent predictors of 90-day favorable functional outcomes in tandem lesion patients treated with EVT. Female sex and longer puncture-to-reperfusion time appear to be potential risk factors for symptomatic intracranial hemorrhage. Emergent carotid artery stenting was not found to be an independent predictor of 90-day functional prognosis in our cohort, and no significant increase in sICH risk was observed in association with eCAS. These preliminary findings require further validation in large-scale multicenter prospective studies.