Thrombectomy in Posterior Circulation Tandem Occlusions: Multicenter Comparative Analysis of Procedural Techniques and Predictors of Clinical Outcomes - PubMed

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Thrombectomy in posterior circulation tandem occlusions (intracranial occlusion with concurrent vertebral artery stenosis/occlusion) was analyzed in a multicenter study of 123 patients from 15 North American centers (February 2016 to October 2023).
Successful reperfusion (mTICI score ≥2b) was achieved in 88.5% of patients, symptomatic intracranial hemorrhage occurred in 8.9%, and at 90 days, 47.0% had a favorable functional outcome (mRS score 0-3) while 31.6% died.
A distal-first thrombectomy strategy (treating distal lesion first) was associated with shorter puncture-to-reperfusion times, lower symptomatic intracranial hemorrhage rates, and predicted favorable functional outcomes in multivariable analysis.
Other predictors of favorable outcomes included prestroke antithrombotic use, monitored anesthesia care, and successful reperfusion; predictors of unfavorable outcomes were hyperglycemia, hypertension, higher baseline mRS score, and higher NIHSS score at presentation.
Rescue stenting was required in 39.0% of patients, more commonly for proximal lesions, and combined stent retriever and aspiration was the most common distal thrombectomy technique (36.6%).

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