{
  "abstract": "Background The different pathophysiological mechanisms leading to tandem occlusion (TO), namely arterial dissection or atherosclerosis, may have an impact on the outcome of patients with acute ischemic stroke (AIS) undergoing endovascular thrombectomy (EVT).Methods Consecutive AIS patients with occlusion of the cervical internal carotid artery and concomitant intracranial large vessel occlusion who received EVT between 2011 and 2023 as part of the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) were deemed eligible. We compared clinical and radiological outcomes of patients with dissecting TO versus atherosclerotic TO by the propensity score matching approach.Results Overall, 2148 patients (mean age 69.3±12.8 years; males 64.5%) qualified for the analysis. Of these, 236 (10.9%) had dissecting TO, and 1912 (89.1%) atherosclerotic TO. As expected, patients with dissecting TO stroke were younger and had a lower burden of major cardiovascular risk factors. In the matched cohort, we observed no difference between the two groups in either 90-day functional independence (OR 1.33; 95% CI 0.94 to 1.83; p=0.115) or in any of the secondary endpoints, except for a reduced risk of parenchymal hematoma type 2 (OR 0.37; 95% CI 0.14 to 0.98; p=0.046) in the group of patients with dissecting TO stroke, which, however, did not affect patient outcome.Conclusions The outcome of patients undergoing EVT because of dissecting TO stroke does not differ from that of patients with atherosclerotic TO stroke. The etiology of the underlying vascular lesion should not be regarded as a contraindication to EVT procedures in these cases.",
  "authors": [
    {
      "affiliations": [
        "Department of Medicine and Surgery, University of Parma, Parma, Italy",
        "Department of Emergencies, Stroke Care Program, Parma University Hospital, Parma, Italy"
      ],
      "name": "Alessandro Pezzini"
    },
    {
      "affiliations": [
        "Diagnostic Department, University Hospital of Parma, Parma, Italy"
      ],
      "name": "Roberto Menozzi"
    },
    {
      "affiliations": [
        "Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy"
      ],
      "name": "Giovanni Pracucci"
    },
    {
      "affiliations": [
        "Neurology and Stroke Unit, Hospital Santa Corona Pietra Ligure, Pietra Ligure, Italy"
      ],
      "name": "Valentina Saia"
    },
    {
      "affiliations": [
        "Clinical and Epidemiological Research Unit, University Hospital of Parma, Parma, Italy"
      ],
      "name": "Matteo Puntoni"
    },
    {
      "affiliations": [
        "Clinical and Epidemiological Research Unit, University Hospital of Parma, Parma, Italy"
      ],
      "name": "Giuseppe Maglietta"
    },
    {
      "affiliations": [
        "Clinical and Epidemiological Research Unit, University Hospital of Parma, Parma, Italy"
      ],
      "name": "Caterina Caminiti"
    },
    {
      "affiliations": [
        "Dipartimento di Scienze Biomediche, Università degli Studi di Firenze, Florence, Italy"
      ],
      "name": "Enrico Fainardi"
    },
    {
      "affiliations": [
        "Department of Biomedical and Surgical Sciences, University of Ferrara, Ferrara, Italy"
      ],
      "name": "Ilaria Casetta"
    },
    {
      "affiliations": [
        "Ospedale dei Castelli, Ariccia, Italy"
      ],
      "name": "Fabrizio Sallustio"
    },
    {
      "affiliations": [
        "University of Rome Tor Vergata, Rome, Italy"
      ],
      "name": "Valerio Da Ros"
    },
    {
      "affiliations": [
        "University of Rome Tor Vergata, Rome, Italy"
      ],
      "name": "Alfredo Paolo Mascolo"
    },
    {
      "affiliations": [
        "University of Florence, Florence, Italy"
      ],
      "name": "Patrizia Nencini"
    },
    {
      "affiliations": [
        "Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy"
      ],
      "name": "Stefano Vallone"
    },
    {
      "affiliations": [
        "Neurology Unit, Azienda Ospedaliero-Universitaria di Modena Ospedale Civile di Baggiovara, Modena, Italy"
      ],
      "name": "Guido Bigliardi"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Bufalini Hospital, AUSL Romagna, Cesena, Italy"
      ],
      "name": "Maria Ruggiero"
    },
    {
      "affiliations": [
        "Stroke Unit, Bufalini Hospital, AUSL Romagna, Cesena, Italy"
      ],
      "name": "Sara Biguzzi"
    },
    {
      "affiliations": [
        "Department of Neuroscience, University of Turin, Turin, Italy"
      ],
      "name": "Mauro Bergui"
    },
    {
      "affiliations": [
        "Stroke Unit, AOU Città della Salute, Molinette Hospital, Turin, Italy"
      ],
      "name": "Giovanni Bosco"
    },
    {
      "affiliations": [
        "Neuroradiology Maggiore H, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy"
      ],
      "name": "Luigi Simonetti"
    },
    {
      "affiliations": [
        "Neurology and Stroke Center, Maggiore Hospital, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy"
      ],
      "name": "Andrea Zini"
    },
    {
      "affiliations": [
        "Neuroradiology, San Giovanni Bosco Hospital, Turin, Italy"
      ],
      "name": "Andrea Boghi"
    },
    {
      "affiliations": [
        "Neurology Unit, San Giovanni Bosco Hospital, Turin, Italy"
      ],
      "name": "Andrea Naldi"
    },
    {
      "affiliations": [
        "Neuroradiology Unit, University of Messina Faculty of Medicine and Surgery, Messina, Italy"
      ],
      "name": "Sergio Lucio Vinci"
    },
    {
      "affiliations": [
        "Clinical and Experimental Medicine, University of Messina Faculty of Medicine and Surgery, Messina, Italy"
      ],
      "name": "Paolino La Spina"
    },
    {
      "affiliations": [
        "Integrated University Hospital of Verona Campus Borgo Trento, Verona, Italy"
      ],
      "name": "Nicolò Mandruzzato"
    },
    {
      "affiliations": [
        "Azienda Ospedaliera Universitaria Integrata Verona Sede di Borgo Trento, Verona, Italy"
      ],
      "name": "Manuel Cappellari"
    },
    {
      "affiliations": [
        "Siena University Hospital, Siena, Italy"
      ],
      "name": "Sandra Bracco"
    },
    {
      "affiliations": [
        "Siena University Hospital, Siena, Italy"
      ],
      "name": "Francesca Rosini"
    },
    {
      "affiliations": [
        "Servizio di Neuroradiologia, University Hospital of Ferrara Arcispedale Sant’Anna Medical Department, Cona, Italy"
      ],
      "name": "Andrea Saletti"
    },
    {
      "affiliations": [
        "Neurology Division-Stroke Unit, University Hospital of Ferrara Arcispedale Sant’Anna Medical Department, Cona, Italy"
      ],
      "name": "Alessandro De Vito"
    },
    {
      "affiliations": [
        "Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy"
      ],
      "name": "Mirco Cosottini"
    },
    {
      "affiliations": [
        "Department of Experimental and Clinical Medicine, Neurological Institute, Pisa University, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy"
      ],
      "name": "Nicola Giannini"
    },
    {
      "affiliations": [
        "Servizio di Neuroradiologia, Bolzano Hospital, Bolzano, Italy"
      ],
      "name": "Alessio Comai"
    },
    {
      "affiliations": [
        "Neurologia, Bolzano Hospital, Bolzano, Italy"
      ],
      "name": "Enrica Franchini"
    },
    {
      "affiliations": [
        "SS Interventional Neuroradiology, Fondazione IRCCS San Matteo Hospital, Pavia, Italy"
      ],
      "name": "Sergio Nappini"
    },
    {
      "affiliations": [
        "Neurology and Stroke Unit, IRCCS Fondazione “C. Mondino”, Pavia, Italy"
      ],
      "name": "Carmelo Tiberio Currò"
    },
    {
      "affiliations": [
        "Neuroradiology, IRCCS San Martino Hospital, Genoa, Italy"
      ],
      "name": "Lucio Castellan"
    },
    {
      "affiliations": [
        "Neurology, IRCCS San Martino Hospital, Azienda Ospedaliera Metropolitana (AOM) of Genoa, Genoa, Italy"
      ],
      "name": "Davide Sassos"
    },
    {
      "affiliations": [
        "Emergency Department, University of Rome La Sapienza, Rome, Italy"
      ],
      "name": "Antonio Ciacciarelli"
    },
    {
      "affiliations": [
        "Department of Human Neurosciences, Stroke Unit, Universita degli Studi di Roma La Sapienza, Roma, Italy"
      ],
      "name": "Ettore Nicolini"
    },
    {
      "affiliations": [
        "Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, Italy"
      ],
      "name": "Domenico Sergio Zimatore"
    },
    {
      "affiliations": [
        "Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari ‘Aldo Moro’, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, Italy"
      ],
      "name": "Marco Petruzzellis"
    },
    {
      "affiliations": [
        "Neuroradiology, Santa Corona Hospital, Pietra Ligure, Italy"
      ],
      "name": "Diego Ivaldi"
    },
    {
      "affiliations": [
        "Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy"
      ],
      "name": "Elena Tiziana Coco"
    },
    {
      "affiliations": [
        "Interventional Radiology, Azienda Sanitaria Locale Taranto, Taranto, Italy"
      ],
      "name": "Maria Porzia Ganimede"
    },
    {
      "affiliations": [
        "Neurology and Stroke Unit, Azienda Sanitaria Locale Taranto, Taranto, Italy"
      ],
      "name": "Angelica Tinelli"
    },
    {
      "affiliations": [
        "Neuroradiologia, Ospedale dell’Angelo-Mestre, Mestre, Italy"
      ],
      "name": "Nicola Cavasin"
    },
    {
      "affiliations": [
        "Neurologia, Ospedale dell’Angelo-Mestre, Mestre, Italy"
      ],
      "name": "Adriana Critelli"
    },
    {
      "affiliations": [
        "Neuroradiologia, ASL 4 Teramo, Teramo, Italy"
      ],
      "name": "Edoardo Puglielli"
    },
    {
      "affiliations": [
        "Neurologia, ASL 4 Teramo, Teramo, Italy"
      ],
      "name": "Alfonsina Casalena"
    },
    {
      "affiliations": [
        "Ospedale Vito Fazzi, Lecce, Italy"
      ],
      "name": "Adriana Paladini"
    },
    {
      "affiliations": [
        "Department of Neurology, Ospedale Vito Fazzi, Lecce, Italy"
      ],
      "name": "Marcella Caggiula"
    },
    {
      "affiliations": [
        "Presidio Ospedaliero di Avezzano, Avezzano, Italy"
      ],
      "name": "Marco Perri"
    },
    {
      "affiliations": [
        "Department of Neurology, AUSL di Avezzano Sulmona e L’Aquila, L’Aquila, Italy"
      ],
      "name": "Federica De Santis"
    },
    {
      "affiliations": [
        "Azienda Ospedaliera Santa Maria di Terni, Terni, Italy"
      ],
      "name": "Massimiliano Allegritti"
    },
    {
      "affiliations": [
        "Azienda Ospedaliera Santa Maria di Terni, Terni, Italy"
      ],
      "name": "Stefano Caproni"
    },
    {
      "affiliations": [
        "Neuroradiology, Department of Neuroscience, ASST Cremona, Cremona, Italy"
      ],
      "name": "Michele Besana"
    },
    {
      "affiliations": [
        "Neurology, Department of Neuroscience, ASST Cremona, Cremona, Italy"
      ],
      "name": "Alessia Giossi"
    },
    {
      "affiliations": [
        "Neuroradiology, Poliambulanza Brescia Hospital, Brescia, Italy"
      ],
      "name": "Matteo Alberti"
    },
    {
      "affiliations": [
        "Neurologia, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy"
      ],
      "name": "Paolo Invernizzi"
    },
    {
      "affiliations": [
        "Neuroradiologia, Azienda Ospedaliera Nazionale Santi Antonio e Biagio e Cesare Arrigo Alessandria, Alessandria, Italy"
      ],
      "name": "Ivan Gallesio"
    },
    {
      "affiliations": [
        "Neurologia AOU, Antonio e Biagio e Cesare Arrigo University Hospital Alessandria, Alessandria, Italy"
      ],
      "name": "Alessandro Canessa"
    },
    {
      "affiliations": [
        "UOC Neuroradiologia, Rovigo Hospital, Rovigo, Italy"
      ],
      "name": "Giuseppe Carità"
    },
    {
      "affiliations": [
        "Stroke Unit, Ospedale Civile di Rovigo, Rovigo, Italy"
      ],
      "name": "Monia Russo"
    },
    {
      "affiliations": [
        "Ospedale Santa Maria Goretti, Latina, Italy"
      ],
      "name": "Giuseppe Pelle"
    },
    {
      "affiliations": [
        "Ospedale Santa Maria Goretti, Latina, Italy"
      ],
      "name": "Michele Alessiani"
    },
    {
      "affiliations": [
        "Neuroradiology, Sant’Andrea Hospital, Rome, Italy"
      ],
      "name": "Francesco Arbia"
    },
    {
      "affiliations": [
        "Neuroradiology, Santa Maria della Misericordia University Hospital, Udine, Italy"
      ],
      "name": "Vladimir Gavrilovic"
    },
    {
      "affiliations": [
        "Department of Head, Neck and Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy"
      ],
      "name": "Giovanni Merlino"
    },
    {
      "affiliations": [
        "Radiology, Ospedale Civico Palermo, Palermo, Italy"
      ],
      "name": "Marco Filizzolo"
    },
    {
      "affiliations": [
        "Neurology, Ospedale Civico Palermo, Palermo, Italy"
      ],
      "name": "Marina Mannino"
    },
    {
      "affiliations": [
        "Vascular and Interventional Radiology, Sassari University Hospital, Sassari, Italy"
      ],
      "name": "Maria Cristina Fancello"
    },
    {
      "affiliations": [
        "Stroke Unit, Sassari University Hospital Department of Medicine, Sassari, Italy"
      ],
      "name": "Alessandra Sanna"
    },
    {
      "affiliations": [
        "Neuroradiologia, University Hospital Careggi, Florence, Italy"
      ],
      "name": "Salvatore Mangiafico"
    },
    {
      "affiliations": [
        "Neurological Sciences, Università degli Studi di Roma La Sapienza, Rome, Italy"
      ],
      "name": "Danilo Toni"
    },
    {
      "affiliations": [],
      "name": "on behalf of the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) Group"
    }
  ],
  "title": "Outcome of patients with dissecting versus atherosclerotic tandem occlusion acute ischemic stroke",
  "uid": "972580d3-fc88-5227-90f8-2605b89bfec3"
}