The ReWiSed CARe Technique : Simultaneous Treatment of Atherosclerotic Tandem Occlusions in Acute Ischemic Stroke

Background: Endovascular treatment of acute cerebral large vessel occlusions and concomitant atherosclerotic lesions of the ipsilateral internal carotid artery (ICA) are a matter of debate. This article reports a multi-center experience using the retriever wire supported carotid artery revascularization (ReWiSed CARe) technique allowing simultaneous treatment of both lesions.

Methods: The study retrospectively analyzed 23 patients with acute tandem occlusions (TO) who underwent ReWiSed CARe at 3 German centers. Clinical, including demographics and National Institutes of Health Stroke Scale (NIHSS) and procedural, including angiographic evaluation of recanalization, data were evaluated. Favorable clinical outcome was defined as modified Rankin Scale (mRS) score ≤2 at 90 days.

Results: The median age was 70 years (interquartile range [IQR] 65-80 years) and 70% were male. The median baseline NIHSS was 15 (IQR 11-17). Out of 23 patients, 22 (96%) had an intracranial occlusion of the anterior circulation. Successful stent retriever deployment with subsequent carotid artery treatment was feasible in all cases without displacement of the stent retriever during the procedure. Overall, successful reperfusion (modified Thrombolysis in Cerebral Infarction [mTICI] ≥2b) was achieved in 22/23 (96%) patients with 10/23 (44%) individuals completely reperfused (mTICI 3). The median groin puncture to stent retriever deployment was 29 min (IQR 23-46) and groin puncture to final revascularization was 63 min (IQR 56-78). The median NIHSS at discharge was 5 (IQR 3-12) with favorable clinical outcome at 90 days in 11 out of 20 patients (55%).

Conclusion: Endovascular treatment using ReWiSed CARe is safe, fast and efficient in TO patients with underlying atherosclerotic lesion of the extracranial ICA.