Sistema de Salut de Catalunya
Institut Català de la Salut
[Romano DG] Unit of Interventional Neuroradiology, University Hospital Salerno, Salerno, Italy. [Tortora R] Unit of Interventional Neuroradiology, University Hospital Salerno, Salerno, Italy. Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy. [De Simone M] Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, Italy. Neuroanatomy Unit, BrainLab, Mercato San Severino, Salerno, Italy. Neurosurgery Unit, University Hospital “San Giovanni di Dio e Ruggi D’Aragona”, Salerno, Italy. [Frauenfelder G, Siani A] Unit of Neuoradiology, Department of Diagnostic Imaging, University Hospital Salerno, Salerno, Italy. [Amoroso E] Neurosurgery Unit, University Hospital “San Giovanni di Dio e Ruggi D’Aragona”, Salerno, Italy. [Diana F] Secció de Neurorradiologia Intervencionista, Servei de Radiodiagnòstic, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Grup de Recerca en Ictus, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
Vall d'Hebron Barcelona Hospital Campus
2025-06-11T11:43:02Z
2025-06-11T11:43:02Z
2025-05
Endovascular neurosurgery; Internal carotid artery stenosis; Tandem lesions
Neurocirugía endovascular; Estenosis de la arteria carótida interna; Lesiones en tándem
Neurocirurgia endovascular; Estenosi de l'artèria caròtide interna; Lesions en tàndem
Background: Tandem Lesions (TLs) or Tandem Occlusions (TOs) are characterized by simultaneous high-grade stenosis or occlusion of the proximal extracranial internal carotid artery and the intracranial terminal internal carotid artery or its branches. These lesions can result in stroke and pose significant challenges to endovascular treatment. This study introduces and evaluates the “T-Top technique” as an innovative approach to address TLs, assessing its safety and technical efficacy. Methods: Data from acute ischemic stroke (AIS) patients treated with the T-Top technique between September 2022 and September 2023 were retrospectively analyzed. The technique involves using the pusher wire of a stent retriever as a microwire to guide a monorail angioplastic balloon to the extracranial carotid stenosis, performing angioplasty simultaneously with stent retriever anchorage. Clinical outcomes, procedural data, and safety were assessed. Results: Successful reperfusion (mTICI > 2b) was achieved in 91% of cases, with a median groin puncture to final recanalization time of 50 min. Favorable clinical outcomes (mRS < 3) were observed in 69% of patients, with a low mortality rate of 6% after 90 days. Conclusions: The T-Top technique offers a rapid and reliable strategy for TL treatment, improving reperfusion rates and clinical outcomes. Further studies are warranted to validate its efficacy in larger cohorts. This technique holds promise for enhancing endovascular treatment outcomes in patients with Tandem Lesions.
Article
Published version
English
Malalties cerebrovasculars - Tractament; Malalties cerebrovasculars - Cirurgia; Vasos sanguinis - Cirurgia; Avaluació de resultats (Assistència sanitària); DISEASES::Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Cerebrovascular Disorders::Stroke; Other subheadings::Other subheadings::Other subheadings::/surgery; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Surgical Procedures, Operative::Cardiovascular Surgical Procedures::Vascular Surgical Procedures::Thrombectomy; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Surgical Procedures, Operative::Cardiovascular Surgical Procedures::Vascular Surgical Procedures::Endovascular Procedures; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Prognosis::Treatment Outcome; ENFERMEDADES::enfermedades del sistema nervioso::enfermedades del sistema nervioso central::enfermedades cerebrales::trastornos cerebrovasculares::accidente cerebrovascular; Otros calificadores::Otros calificadores::Otros calificadores::/cirugía; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::intervenciones quirúrgicas::procedimientos quirúrgicos cardiovasculares::procedimientos quirúrgicos vasculares::trombectomía; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::intervenciones quirúrgicas::procedimientos quirúrgicos cardiovasculares::procedimientos quirúrgicos vasculares::procedimientos endovasculares; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::pronóstico::resultado del tratamiento
MDPI
Journal of Clinical Medicine;14(9)
https://doi.org/10.3390/jcm14092945
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
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