Clinical characteristics and outcomes of tandem lesions involving internal carotid artery occlusion and distal middle cerebral artery occlusion.

BACKGROUND

Tandem lesions involving internal carotid artery occlusion (ICAO) and distal middle cerebral artery occlusion (MCAO) are rare, and evidence regarding their clinical characteristics, management strategies, and outcomes remains limited. We aimed to describe real-world treatments and clinical outcomes in patients with this condition at a single comprehensive stroke center.

METHODS

We reviewed consecutive patients included in our stroke registry between 2009 and 2022 and identified those with ICAO and distal MCAO (M3 or M4 segments). We described the use of thrombolysis, mechanical thrombectomy (MT) and/or carotid revascularization procedures (percutaneous transluminal angioplasty (PTA), carotid artery stenting (CAS), carotid endarterectomy (CEA)). Baseline National Institutes of Health Stroke Scale (NIHSS) scores and 3-month functional outcomes (modified Rankin Scale (mRS)) were descriptively compared between patients who did and did not receive reperfusion and/or revascularization therapies.

RESULTS

In 100 acute ischemic stroke patients with ICAO, 28 had tandem lesions with distal MCAO. Of these, 11 (39%) received reperfusion and/or revascularisation therapies: five patients received thrombolysis only, two MT only, one thrombolysis, MT and CAS, one MT and PTA, one thrombolysis and CEA, and one CEA. Treated patients had a higher median baseline NIHSS (9 [5-19] versus 4 [2-8] for non-treated, p < 0.05). No patients had a symptomatic hemorrhagic transformation. At 3 months, there was no significant difference in functional outcomes between the two groups (55% mRS 0-2, treated, 65% in non-treated, p = 0.59).

CONCLUSION

In this study, patients with tandem lesions involving ICAO and distal MCAO demonstrated heterogeneous clinical presentations and management strategies.