J Stroke.  2025 Jan;27(1):75-84. 10.5853/jos.2024.03055.

Endovascular Treatment for Acute Posterior Circulation Tandem Lesions: Insights From the BASILAR and PERSIST Registries

• Li W
• Doheim MF
• Qiu Z
• Wang T
• Chen Z
• Zi W
• Yang Q
• Guan H
• Qiao H
• Liu W
• Hu W
• Liu X
• Huang J
• Han Z
• Chen Z
• Zhao Z
• Sun W
• Nogueira RG

• KMID: 2564264
• DOI: http://doi.org/10.5853/jos.2024.03055

Abstract

Background and Purpose
Limited evidence exists on the effectiveness of endovascular treatment (EVT) for acute posterior circulation tandem lesion (PCTL). This study aimed to explore the role of extracranial vertebral artery (VA) stenting in patients with PCTL stroke undergoing EVT.
Methods
Individual patient data were pooled from the BASILAR (EVT for Acute Basilar Artery Occlusion Study) and PERSIST (Posterior Circulation Ischemic Stroke) registries. Patients with PCTLs who underwent EVT were included in the present cohort and divided into the stenting and nonstenting groups based on the placement of extracranial VA stents. The primary efficacy outcome was the modified Rankin Scale (mRS) scores at 90 days and 1 year. Safety outcomes included 24-hour symptomatic intracranial hemorrhage (sICH) and all-cause mortality at 90 days and 1 year post-surgery.
Results
A combined dataset of 1,320 patients with posterior circulation artery occlusion, including 263 (19.9%) with tandem lesions, of whom 217 (median age, 65 years; 82.9% male) met the inclusion criteria for the analysis. The stenting group had 84 (38.7%) patients, while the non-stenting group had 133 (61.3%). After adjustment for the potential confounders, extracranial VA stenting was associated with favorable shifts in mRS scores at both 90 days (adjusted common odds ratio [OR], 2.30; 95% confidence interval [CI], 1.23–4.28; P<0.01) and 1 year (adjusted OR [aOR], 2.04; 95% CI [1.05–3.97]; P=0.04), along with lower rate of mortality at both 90 days (aOR, 0.45; 95% CI [0.21–0.93]; P=0.01) and 1 year (aOR, 0.36; 95% CI [0.16–0.79]; P=0.01), with no significant difference in sICH incidence (aOR, 0.35; 95% CI [0.06–1.98]; P=0.24).
Conclusion
Extracranial VA stenting during EVT may improve functional outcomes and reduce mortality in patients with PCTL strokes.

Keyword

Acute ischemic stroke; Endovascular treatment; Posterior circulation artery occlusion; Tandem lesion

Figure

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  Figure 1. Flowchart of patient selection. EVT, endovascular treatment; BASILAR, EVT for Acute Basilar Artery Occlusion Study; PERSIST, Posterior Circulation Ischemic Stroke; MT, mechanical thrombectomy; IA, intra-arterial.

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  Figure 2. Distribution of modified Rankin Scale (mRS) score at 90 days between the stenting and non-stenting groups (mRS ordinal shift: adjusted common odds ratio 2.08, 95% confidence interval [1.09–3.95], P=0.03).

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  Figure 3. Distribution of modified Rankin Scale (mRS) score at 1 year between the stenting and non-stenting groups (mRS ordinal shift: adjusted common odds ratio 1.81, 95% confidence interval [0.95–3.46], P=0.07).

Reference

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