{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T23:26:23Z","timestamp":1792193183994,"version":"4.4.0"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Purpose:<\/jats:title>\n                    <jats:p>Tandem lesions in the anterior circulation account for up to 30% of all large vessel occlusion strokes. The optimal periprocedural approach in these lesions is still a matter of debate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Data from the German Stroke Registry\u2014Endovascular Treatment between June 2015 and December 2019 were analyzed. The German Stroke Registry\u2014Endovascular Treatment is an academic, independent, prospective, multicenter, observational registry study with 25 participating stroke centers from all over Germany enrolling consecutive mechanical thrombectomy patients. Tandem lesions were defined as a combination of a relevant extracranial internal carotid artery (ICA) pathology (ipsilateral stenosis &gt;70% or occlusion) and concomitant intracranial large vessel occlusion. Successful reperfusion was defined as modified Thrombolysis in Cerebral Infarction score of 2b-3. The modified Rankin Scale score of 0 to 2 at 3 months indicated good outcome. The aim of this study was to investigate the safety and efficacy of different technical strategies in tandem lesions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Out of 6635 patients, 874 (13.2%) presented with tandem lesions. Of these, 607 (69.5%) underwent acute treatment of the extracranial ICA. Acute treatment of the extracranial ICA lesion led to a higher probability of successful reperfusion (odds ratio, 40.63 [95% CI, 30.03\u201370.06]) compared with patients who did not undergo acute treatment of the extracranial ICA lesion and was associated with good clinical outcome (39.5% versus 29.3%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001) and a lower rate of mortality (17.1% versus 27.1%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001) at 3 months. Further significant predictors of successful reperfusion were age (odds ratio, 0.98 [95% CI, 0.96\u20130.99];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.035) and intravenous thrombolysis (odds ratio, 10.58 [95% CI, 10.04\u201320.4];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.033). Intracranial-first approach (n=227) compared with extracranial-first approach (n=267) resulted in a shorter time to flow restoration (53.5 versus 72.0 minutes,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001) and a higher nonsignificant probability of good outcome (45.8% versus 33.0%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.24) without differences in periprocedural complications.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In tandem lesions in the anterior circulation, acute treatment of the extracranial ICA lesion is associated with better clinical outcome and lower mortality. The intracranial-first approach might provide advantages.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.120.031797","type":"journal-article","created":{"date-parts":[[2021,2,16]],"date-time":"2021-02-16T14:56:12Z","timestamp":1613487372000},"page":"1265-1275","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":71,"title":["Tandem Lesions in Anterior Circulation Stroke"],"prefix":"10.1161","volume":"52","author":[{"given":"Katharina","family":"Feil","sequence":"first","affiliation":[{"name":"Department of Neurology (K.F., C.K., D.C.T., M.D., L.K.), Ludwig Maximilians Universit\u00e4t, Munich, Germany."},{"name":"Department of Neurology and Stroke, Eberhard-Karls University, T\u00fcbingen, Germany (K.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8799-9333","authenticated-orcid":true,"given":"Moriz","family":"Herzberg","sequence":"additional","affiliation":[{"name":"Institute of Neuroradiology (M.H., F.D., T.L.), Ludwig Maximilians Universit\u00e4t, Munich, Germany."},{"name":"Department of Radiology, University Hospital, W\u00fcrzburg, Germany (M.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franziska","family":"Dorn","sequence":"additional","affiliation":[{"name":"Institute of Neuroradiology (M.H., F.D., T.L.), Ludwig Maximilians Universit\u00e4t, Munich, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8817-8457","authenticated-orcid":true,"given":"Steffen","family":"Tiedt","sequence":"additional","affiliation":[{"name":"Institute for Stroke and Dementia Research (ISD), University Hospital (S.T., K.D.), Ludwig Maximilians Universit\u00e4t, Munich, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3919-639X","authenticated-orcid":true,"given":"Clemens","family":"K\u00fcpper","sequence":"additional","affiliation":[{"name":"Department of Neurology (K.F., C.K., D.C.T., M.D., L.K.), Ludwig Maximilians Universit\u00e4t, Munich, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4319-7734","authenticated-orcid":true,"given":"Dennis C.","family":"Thunstedt","sequence":"additional","affiliation":[{"name":"Department of Neurology (K.F., C.K., D.C.T., M.D., L.K.), Ludwig Maximilians Universit\u00e4t, Munich, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiotis","family":"Papanagiotou","sequence":"additional","affiliation":[{"name":"Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Greece (P.P.)."},{"name":"Department of Neurology, Klinikum 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