{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,30]],"date-time":"2025-08-30T16:26:27Z","timestamp":1756571187328,"version":"3.41.2"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"22","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2024,11,19]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Recent trials confirmed the efficacy and safety of endovascular thrombectomy in patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS); however, evidence in tandem lesions is limited. This study evaluates endovascular thrombectomy safety and efficacy in patients with acute large\u2010vessel occlusion with tandem lesions, stratified by baseline ASPECTS.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We conducted a retrospective analysis of data from 16 centers. Inclusion criteria included the following: age \u226518\u2009years, anterior circulation tandem lesions, endovascular thrombectomy &lt;24\u2009hours of symptom onset, and \u226570% internal carotid artery stenosis\/occlusion. Patients were categorized into low (0\u20135) and high (6\u201310) ASPECTS. Inverse probability of treatment weighting matching was used to balance the groups. Primary outcomes included the following: 90\u2010day modified Rankin Scale (mRS) score 0 to 2 and symptomatic intracranial hemorrhage. Secondary outcomes included the following: ordinal mRS, mRS 0 to 3, modified Thrombolysis in Cerebral Infarction \u22652b and 2c\u20103, petechial hemorrhage, parenchymal hematoma (1\/2), early neurologic improvement, and mortality. Of 691 patients, 44 had ASPECTS 0 to 5 and 505 had ASPECTS 6 to 10. Patients with low ASPECTS had lower odds of 90\u2010day mRS 0 to 2 (adjusted odds ratio [OR], 0.48;\n              <jats:italic>P<\/jats:italic>\n              =0.036) and higher odds of symptomatic intracranial hemorrhage (adjusted OR, 3.78;\n              <jats:italic>P<\/jats:italic>\n              =0.014). Additional significant differences were found in mRS shift, mRS 0 to 3, parenchymal hematoma 2, and mortality. In interaction analysis, the association between low ASPECTS and functional outcome persisted only in the internal carotid artery occlusion subgroup, with no significant interaction indicating no reason to suppose a difference between the effect of both subgroups.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Endovascular thrombectomy in patients with tandem lesions with low ASPECTS is associated with reduced odds of functional recovery and increased symptomatic intracranial hemorrhage risk, when compared with patients with high ASPECTS. However, 30% of patients with low ASPECTS achieved 90\u2010day functional independence, suggesting potential benefit for a nonnegligible proportion of patients.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.124.035977","type":"journal-article","created":{"date-parts":[[2024,11,7]],"date-time":"2024-11-07T10:17:39Z","timestamp":1730974659000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Endovascular Treatment of Patients With Acute Ischemic Stroke With Tandem Lesions Presenting With Low Alberta Stroke Program Early Computed Tomography Score"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8107-9632","authenticated-orcid":false,"given":"Milagros","family":"Galecio\u2010Castillo","sequence":"first","affiliation":[{"name":"Department of Neurology University of Iowa Hospitals and Clinics Iowa City IA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3697-5697","authenticated-orcid":false,"given":"Mudassir","family":"Farooqui","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Iowa Hospitals and Clinics Iowa City IA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4781-3944","authenticated-orcid":false,"given":"Waldo R.","family":"Guerrero","sequence":"additional","affiliation":[{"name":"Department of Neurology and Brain Repair University of South Florida Tampa FL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9242-043X","authenticated-orcid":false,"given":"Marc","family":"Ribo","sequence":"additional","affiliation":[{"name":"Department of Neurology Hospital Vall d\u2019Hebron, Barcelona Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7148-7616","authenticated-orcid":false,"given":"Ameer E.","family":"Hassan","sequence":"additional","affiliation":[{"name":"Department of Neurology Valley Baptist Medical Center\/University of Texas Rio Grande Valley Harlingen TX"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7165-797X","authenticated-orcid":false,"given":"Mouhammad A.","family":"Jumaa","sequence":"additional","affiliation":[{"name":"Department of Neurology ProMedica Toledo Hospital Toledo OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8448-0758","authenticated-orcid":false,"given":"Afshin A.","family":"Divani","sequence":"additional","affiliation":[{"name":"University of New Mexico Health Science Center Albuquerque NM"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0407-654X","authenticated-orcid":false,"given":"Michael G.","family":"Abraham","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Kansas Medical Center Kansas City KS"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9711-3340","authenticated-orcid":false,"given":"Nils H.","family":"Petersen","sequence":"additional","affiliation":[{"name":"Department of Neurology Yale University School of Medicine New Haven CT"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7786-5668","authenticated-orcid":false,"given":"Johanna T.","family":"Fifi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Icahn School of Medicine at Mount Sinai New York NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2209-3167","authenticated-orcid":false,"given":"Amer","family":"Malik","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Miami Miller School of Medicine Miami FL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0287-3967","authenticated-orcid":false,"given":"James E.","family":"Siegler","sequence":"additional","affiliation":[{"name":"Cooper Neurological Institute Cooper University Hospital Camden NJ"},{"name":"Cooper Medical School of Rowan University Camden NJ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2810-1685","authenticated-orcid":false,"given":"Thanh N.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Neurology Boston Medical Center Boston MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0602-8509","authenticated-orcid":false,"given":"Sunil A.","family":"Sheth","sequence":"additional","affiliation":[{"name":"Department of Neurology UT Health McGovern Medical School Houston TX"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8694-2645","authenticated-orcid":false,"given":"Guillermo","family":"Linares","sequence":"additional","affiliation":[{"name":"Department of Neurology Saint Louis University St. Louis MO"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7624-3055","authenticated-orcid":false,"given":"Nazli","family":"Janjua","sequence":"additional","affiliation":[{"name":"Asia Pacific Comprehensive Stroke Institute Pomona Valley Hospital Medical Center Pomona CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6981-7540","authenticated-orcid":false,"given":"Jazba","family":"Soomro","sequence":"additional","affiliation":[{"name":"Texas Stroke Institute Dallas\u2013Fort Worth TX"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3627-5439","authenticated-orcid":false,"given":"Darko","family":"Quispe\u2010Orozco","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Iowa Hospitals and Clinics Iowa City IA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4637-1598","authenticated-orcid":false,"given":"Marta","family":"Oliv\u00e9\u2010Gadea","sequence":"additional","affiliation":[{"name":"Department of Neurology Hospital Vall d\u2019Hebron, Barcelona Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5556-5699","authenticated-orcid":false,"given":"Wondewossen G.","family":"Tekle","sequence":"additional","affiliation":[{"name":"Department of Neurology Valley Baptist Medical Center\/University of Texas Rio Grande Valley Harlingen TX"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4967-1801","authenticated-orcid":false,"given":"Syed F.","family":"Zaidi","sequence":"additional","affiliation":[{"name":"Department of Neurology ProMedica Toledo Hospital Toledo OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara Y.","family":"Sabbagh","sequence":"additional","affiliation":[{"name":"University of New Mexico Health Science Center Albuquerque NM"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0037-7222","authenticated-orcid":false,"given":"Tiffany","family":"Barkley","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Kansas Medical Center Kansas City KS"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayush","family":"Prasad","sequence":"additional","affiliation":[{"name":"Department of Neurology Yale University School of Medicine New Haven CT"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9447-5338","authenticated-orcid":false,"given":"Reade A.","family":"De Leacy","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Icahn School of Medicine at Mount Sinai New York NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamad","family":"Abdalkader","sequence":"additional","affiliation":[{"name":"Department of Neurology Boston Medical Center Boston MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2722-7542","authenticated-orcid":false,"given":"Sergio","family":"Salazar\u2010Marioni","sequence":"additional","affiliation":[{"name":"Department of Neurology UT Health McGovern Medical School Houston TX"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weston","family":"Gordon","sequence":"additional","affiliation":[{"name":"Department of Neurology Saint Louis University St. Louis MO"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5179-9209","authenticated-orcid":false,"given":"Charoskhon","family":"Turabova","sequence":"additional","affiliation":[{"name":"Asia Pacific Comprehensive Stroke Institute Pomona Valley Hospital Medical Center Pomona CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8413-6954","authenticated-orcid":false,"given":"Aaron","family":"Rodriguez\u2010Calienes","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Iowa Hospitals and Clinics Iowa City IA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1690-1084","authenticated-orcid":false,"given":"Mahmoud","family":"Dibas","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Iowa Hospitals and Clinics Iowa City IA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4270-8667","authenticated-orcid":false,"given":"Maxim","family":"Mokin","sequence":"additional","affiliation":[{"name":"Department of Neurology and Brain Repair University of South Florida Tampa FL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4739-0133","authenticated-orcid":false,"given":"Dileep R.","family":"Yavagal","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Miami Miller School of Medicine Miami FL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7657-142X","authenticated-orcid":false,"given":"Albert J.","family":"Yoo","sequence":"additional","affiliation":[{"name":"Texas Stroke Institute Dallas\u2013Fort Worth TX"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5726-4478","authenticated-orcid":false,"given":"Amrou","family":"Sarraj","sequence":"additional","affiliation":[{"name":"Department of Neurology University Hospitals Cleveland Medical Center Cleveland OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2619-6975","authenticated-orcid":false,"given":"Tudor G.","family":"Jovin","sequence":"additional","affiliation":[{"name":"Cooper Neurological Institute Cooper University Hospital Camden NJ"},{"name":"Cooper Medical School of Rowan University Camden NJ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3408-1297","authenticated-orcid":false,"given":"Santiago","family":"Ortega\u2010Gutierrez","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Iowa Hospitals and Clinics Iowa City IA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000211"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/archneurol.2012.2569"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000237070.80133.1d"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)00163-X"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2020-015817"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(18)30242-4"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2213379"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2214403"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2118191"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2019-015509"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.07.045120"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.0736"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1056\/nejm199811123392002"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0804656"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.113.001972"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.115.010049"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-12-70"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfab158"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.2053"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1214\/16-STS605"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2017-013316"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000207536"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.118.021893"},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11547-020-01331-7"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1159\/000444069"},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)02032-9"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.118.023689"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000002860"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.124.035977","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,19]],"date-time":"2024-11-19T12:32:39Z","timestamp":1732019559000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.124.035977"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,19]]},"references-count":28,"journal-issue":{"issue":"22","published-print":{"date-parts":[[2024,11,19]]}},"alternative-id":["10.1161\/JAHA.124.035977"],"URL":"https:\/\/doi.org\/10.1161\/jaha.124.035977","relation":{},"ISSN":["2047-9980"],"issn-type":[{"type":"electronic","value":"2047-9980"}],"subject":[],"published":{"date-parts":[[2024,11,19]]},"assertion":[{"value":"2024-04-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-09-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-11-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e035977"}}