| Objective: This study aimed to compare the clinical features,treatment,and clinical outcome of patients with tandem occlusion and those with isolated intracranial occlusion through endovascular treatment.Methods: A retrospective study was performed to analyze 161 patients with acute anterior circulation cerebral infarction who underwent endovascular therapy in the First Affiliated Hospital of Kunming Medical University from January 2017 to March 2022and in West China Hospital of Sichuan University from January 2018 to December2019.Patients were divided into tandem occlusion group and isolated intracranial occlusion group according to preoperative MRA /CTA or intraoperative DSA examination results.The baseline data,etiological classification,treatment,post-stroke complications,image features,and clinical outcome were compared.Univariate analysis and multivariate logistic regression analysis were used to evaluate the related factors of tandem occlusion and isolated intracranial occlusion on postoperative hemorrhage transformation,vascular recanalization degree and clinical outcome.Results: Among 161 patients with acute cerebral infarction,there were 33 cases(20.5%)in the tandem occlusion group and 128 cases(79.5%)in the isolated intracranial occlusion group.Compared with isolated intracranial occlusion,the patients with tandem occlusion had longer time for endovascular procedure [120.00(100.00-153.00)min vs.100.00(60.00-140.00)min,P=0.026] and higher rates of symptomatic intracerebral hemorrhage(27.3% vs.10.2%,P=0.023)and bilateral infarction(15.2%vs.5.5%,P=0.042).In the TOAST etiological classification,the tandem occlusion group was more inclined to the large artery atherosclerosis(63.6%),while the isolated intracranial occlusion group was more inclined to the cardioembolism(53.1%)(P=0.028).There was no significant difference in clinical outcomes between the two groups.Multivariate logistic regression analysis was used to analyze the postoperative hemorrhage transformation in patients with acute anterior circulation cerebral infarction.Results showed high fasting blood glucose(OR=1.258,95%CI:1.097-1.442,P=0.001),electrolyte disorder after stroke(OR=2.602,95%CI:1.191-5.685,P=0.016)and infarction area>1/3(OR=2.783,95%CI:1.308-5.920,P=0.008)were independent predictors for hemorrhage transformation.While tandem occlusion(OR=7.170,95%CI:1.792-28.693,P=0.005),higher systolic blood pressure on admission(OR=1.028,95%CI:1.004-1.053,P=0.025),higher fasting blood glucose(OR=1.312,95%CI:1.090-1.580,P=0.004),respiratory infection after stroke(OR=16.734,95%CI:1.780-157.347,P=0.014)and infarction area>1/3(OR=5.230,95%CI:1.306-20.946,P=0.019)increased the risk of postoperative symptomatic intracranial hemorrhage.In terms of the degree of vascular recanalization,the male was associated with complete recanalization after endovascular treatment(OR=3.237,95%CI:1.067-9.822,P=0.038).Patients had a history of coronary heart disease(OR=0.191,95%CI:0.051-0.712,P=0.014)and prolonged endovascular therapy time(OR=0.980,95%CI:0.970-0.990,P<0.001)were not conducive to complete vascular recanalization.Among the indicators of clinical outcomes,older age(OR=1.047,95%CI:1.013-1.083,P=0.007),high fasting blood glucose(OR=1.282,95%CI:1.039-1.582,P=0.021),infarction area>1/3(OR=5.321,95%CI:2.035-13.913,P=0.001)and hemorrhage transformation(OR=3.533,95%CI:1.275-9.788,P=0.015)were independent predictors of poor functional outcome.In addition,high fasting blood glucose(OR=1.149,95%CI:1.020-1.294,P=0.022),high baseline NIHSS score on admission(OR=1.101,95%CI:1.020-1.189,P=0.014)and infarction area>1/3(OR=3.404,95%CI:1.490-7.780,P=0.004)increased the risk of postoperative death.Except for postoperative symptomatic intracranial hemorrhage,no effect of tandem occlusion on other indicators was found(P> 0.05).Conclusion: Compared with isolated intracranial occlusion,there was not a worse prognosis among patients with tandem occlusion who received EVT. |
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