{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T04:39:22Z","timestamp":1782275962310,"version":"3.54.5"},"reference-count":21,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T00:00:00Z","timestamp":1745452800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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 \u201cT-Top technique\u201d 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 &gt; 2b) was achieved in 91% of cases, with a median groin puncture to final recanalization time of 50 min. Favorable clinical outcomes (mRS &lt; 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.<\/jats:p>","DOI":"10.3390\/jcm14092945","type":"journal-article","created":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T09:26:58Z","timestamp":1745486818000},"page":"2945","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The T-Top Technique for Tandem Lesions: A Single-Center Retrospective Study"],"prefix":"10.3390","volume":"14","author":[{"given":"Daniele Giuseppe","family":"Romano","sequence":"first","affiliation":[{"name":"Unit of Interventional Neuroradiology, University Hospital Salerno, Via San Leonardo, 1, 84131 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaele","family":"Tortora","sequence":"additional","affiliation":[{"name":"Unit of Interventional Neuroradiology, University Hospital Salerno, Via San Leonardo, 1, 84131 Salerno, Italy"},{"name":"Department of Medicine, Surgery and Dentistry \u201cScuola Medica Salernitana\u201d, University of Salerno, Via S. Allende, 84081 Baronissi, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8172-6134","authenticated-orcid":false,"given":"Matteo","family":"De Simone","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Dentistry \u201cScuola Medica Salernitana\u201d, University of Salerno, Via S. Allende, 84081 Baronissi, Italy"},{"name":"Neuroanatomy Unit, BrainLab, Mercato San Severino, 84085 Salerno, Italy"},{"name":"Neurosurgery Unit, University Hospital \u201cSan Giovanni di Dio e Ruggi D\u2019Aragona\u201d, 84131 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Frauenfelder","sequence":"additional","affiliation":[{"name":"Unit of Neuoradiology, Department of Diagnostic Imaging, University Hospital Salerno, Via San Leonardo, 1, 84131 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfredo","family":"Siani","sequence":"additional","affiliation":[{"name":"Unit of Neuoradiology, Department of Diagnostic Imaging, University Hospital Salerno, Via San Leonardo, 1, 84131 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ettore","family":"Amoroso","sequence":"additional","affiliation":[{"name":"Neurosurgery Unit, University Hospital \u201cSan Giovanni di Dio e Ruggi D\u2019Aragona\u201d, 84131 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianpiero","family":"Locatelli","sequence":"additional","affiliation":[{"name":"Unit of Neuoradiology, Department of Diagnostic Imaging, University Hospital Salerno, Via San Leonardo, 1, 84131 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Taglialatela","sequence":"additional","affiliation":[{"name":"Unit of Neuoradiology, Department of Diagnostic Imaging, University Hospital Salerno, Via San Leonardo, 1, 84131 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianmarco","family":"Flora","sequence":"additional","affiliation":[{"name":"Unit of Interventional Neuroradiology, University Hospital Salerno, Via San Leonardo, 1, 84131 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Diana","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology, Vall d\u2019Hebron University Hospital, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain"},{"name":"Stroke Research Group, Vall d\u2019Hebron Research Institute, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renato","family":"Saponiero","sequence":"additional","affiliation":[{"name":"Unit of Neuoradiology, Department of Diagnostic Imaging, University Hospital Salerno, Via San Leonardo, 1, 84131 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1161\/STROKEAHA.118.021893","article-title":"Emergent management of tandem lesions in acute ischemic stroke","volume":"50","author":"Jadhav","year":"2019","journal-title":"Stroke"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1016\/S0140-6736(16)00163-X","article-title":"Endovascular thrombectomy after large-vessel ischaemic stroke: A meta-analysis of individual patient data from five randomised trials","volume":"387","author":"Goyal","year":"2016","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1136\/neurintsurg-2017-013316","article-title":"Acute ischemic stroke with tandem lesions: Technical endovascular management and clinical outcomes from the ESCAPE trial","volume":"10","author":"Assis","year":"2018","journal-title":"J. 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