Objective  To evaluate the safety and efficacy of endovascular of in treating anterior circulation tandem occlusion with large core infarction.
Methods  The clinical and imaging data of the patients with anterior circulation tandem occlusion and large core infarction who were admitted to Daping Hospital, Army Military Medical University from March 2018 to May 2020 were retrospectively analyzed. The preoperative evaluation, surgical approach, operation technique, perioperative management, surgical outcomes and prognosis of the patients were analyzed.
Results  A total of five patients were included, with 4 males and age range 61-71 years old. Of the 5 cases, the initial and terminal segment occlusion of internal carotid artery (ICA) was in one patient, and ICA initial segment occlusion combined with ipsilateral middle cerebral artery (MCA) occlusion was in four patients. All of them underwent distal-to-proximal revascularization by applying the Solitaire stent-retriever half-release protection (Sharp) technique. Two patients underwent ipsilateral ICA stenting immediately after MCA recanalization; in the other two patients, ICA stenting was performed after MCA recanalization and a long time of reperfusion observation; and one patient only underwent balloon dilation of carotid artery after recanalization. All 5 patients got successful recanalization of the occluded vessels without symptomatic intracranial hemorrhage or distal thrombotic events. The time from stroke onset to recanalization was 637.2±172.2 (451-814) minutes, and the time from recanalization to ICA stent implantation was 152.5±92.2 (59-270) minutes. Two patients died from postoperative hyperperfusion (edema), and the other three patients all had a good prognosis (mRS 3) at 90 days after surgery.
Conclusions  Patients with anterior circulation tandem occlusion and large core infarction may benefit from acute endovascular treatment. To reduce the risk of postoperative hyperperfusion, appropriate "reperfusion precondition" time is necessary, then dealing with intracranial lesion, while the optimal precondition time is still uncertain.