{
  "abstract": "Background Endovascular thrombectomy (EVT) is the standard of care for patients with acute ischemic stroke (AIS) and intracranial vessel occlusion. Tandem occlusions (TO) comprise 20% of all anterior circulation AIS and are related to a poorer prognosis. The optimal EVT treatment strategy remains controversial. Our main objective was to determine if simultaneous endovascular treatment of intracranial and extracranial occlusions in patients with TO results in faster recanalization times, with similar efficacy and safety, compared with the sequential approach.Methods Single center, retrospective analysis of patients with TO undergoing EVT using the simultaneous or sequential technical approach. The primary outcome was puncture-to-final recanalization time. Secondary outcomes included modified Rankin scale (mRS) score at 3 months, 30 day mortality, and hemorrhagic transformation.Results We included 111 patients with TO (35 treated with the simultaneous approach and 76 treated with the sequential approach). Successful recanalization was achieved in 91.9% of cases, and the first pass effect was 50.5%, with no differences between groups. The simultaneous technique resulted in shorter puncture-to-final recanalization time (33.0 min (IQR 25.0–55.0) vs 52.0 (30.0–73.0), P=0.018), adjusting for number of passes, first pass effect, thrombolysis, age, and previous stroke (adjusted β −0.21 (95% CI −29.47 to −2.79); P=0.018). No significant differences were found in 30 day functional outcome, mortality, or rate of hemorrhagic transformation when comparing simultaneous and sequential techniques.Conclusion The simultaneous approach was effective, safe, and faster than the classic sequential approach in patients with TO. This result may obviate the debate over which occlusion should be addressed first during EVT.",
  "authors": [
    {
      "affiliations": [
        "Department of Medical Imaging, University of Western Ontario, London, Ontario, Canada"
      ],
      "name": "Ruba Kiwan"
    },
    {
      "affiliations": [
        "Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada"
      ],
      "name": "Alonso Alvarado-Bolanos"
    },
    {
      "affiliations": [
        "Department of Medical Imaging, University of Western Ontario, London, Ontario, Canada",
        "Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine"
      ],
      "name": "Mosab Maree"
    },
    {
      "affiliations": [
        "Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada"
      ],
      "name": "Maria Bres-Bullrich"
    },
    {
      "affiliations": [
        "Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada",
        "Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia"
      ],
      "name": "Annika Mascarenhas"
    },
    {
      "affiliations": [
        "Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada",
        "Department of Neurosurgery, Paracelsus Medical University, Salzburg, Austria"
      ],
      "name": "Gökce Hatipoglu Majernik"
    },
    {
      "affiliations": [
        "University of Western Ontario, London, Ontario, Canada"
      ],
      "name": "Alistair Jukes"
    },
    {
      "affiliations": [
        "Department of Medical Imaging, University of Western Ontario, London, Ontario, Canada"
      ],
      "name": "Lisa Xuan"
    },
    {
      "affiliations": [
        "Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada"
      ],
      "name": "Victor Yang"
    },
    {
      "affiliations": [
        "Department of Medical Imaging, University of Western Ontario, London, Ontario, Canada",
        "Department of Clinical and Neurological Sciences, University of Western Ontario, London, Ontario, Canada"
      ],
      "name": "Michael Mayich"
    },
    {
      "affiliations": [
        "Department of Medical Imaging, University of Western Ontario, London, Ontario, Canada"
      ],
      "name": "Manas Sharma"
    },
    {
      "affiliations": [
        "Department of Clinical and Neurological Sciences, University of Western Ontario, London, Ontario, Canada"
      ],
      "name": "Melfort Boulton"
    },
    {
      "affiliations": [
        "Department of Medical Imaging, University of Western Ontario, London, Ontario, Canada"
      ],
      "name": "Sachin K Pandey"
    }
  ],
  "title": "Simultaneous approach in tandem occlusion: a safe, effective, and faster way to achieve recanalization",
  "uid": "bff0fcfc-f3f0-55ae-99f6-b5dc1ed7f6f7"
}