Triple Platelet Inhibition in Intracranial Thrombectomy with Additional Acute Cervical Stent Angioplasty due to Tandem Lesion: A retrospective single-center analysis

Triple Platelet Inhibition in Intracranial Thrombectomy with Additional Acute Cervical Stent Angioplasty due to Tandem Lesion: A retrospective single-center analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Triple Platelet Inhibition in Intracranial Thrombectomy with Additional Acute Cervical Stent Angioplasty due to Tandem Lesion: A retrospective single-center analysis Ali Khanafer, Hans Henkes, Philipp Bücke, Florian Hennersdorf, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3848031/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Mar, 2024 Read the published version in BMC Neurology → Version 1 posted 10 You are reading this latest preprint version Abstract Background Acute stroke treatment with intracranial thrombectomy and treatment of ipsilateral carotid artery stenosis/occlusion (“tandem lesion”, TL) in one session is considered safe. However, the risk of stent restenosis after TL treatment is high, and antiplatelet therapy (APT) preventing restenosis must be well balanced to avoid intracranial hemorrhage. We investigated the safety and 90-day outcome of patients receiving TL treatment under triple-APT, focused on stent-patency and possible disadvantageous comorbidities. Methods Patients receiving TL treatment in the setting of acute stroke between 2013 and 2022 were analyzed regarding peri-/postprocedural safety and stent patency after 90 days. All patients received intravenous eptifibatide and acetylsalicylic acid and one of the three drugs prasugrel, clopidogrel, or ticagrelor. Duplex imaging was performed 24h after treatment, at discharge and 90 days, and digital subtraction angiography was performed if restenosis was suspected. Results 176 patients were included. Periprocedural complications occurred in 2.3% of the patients at no periprocedural death, and in-hospital death in 13.6%. Discharge mRS score was maintained or improved at the 90-day follow-up in 86%, 4.54% had an in-stent restenosis requiring treatment at 90 days. No recorded comorbidity considered disadvantageous for stent patency showed statistical significance, the duration of the endovascular procedure had no significant effect on outcome. Conclusion TL treatment with triple APT resulted in a lower restenosis rate, comparable rates of sICH and mRS in comparison to single and dual APT. Aggressive APT in the initial phase may therefore prevent recurrent stroke better than restrained platelet inhibition. Comorbidities did not influence stent patency. Stroke Carotid artery stenting Endovascular thrombectomy In-Stent restenosis anti-platelet therapy Background Since the publication of the trial data by MR CLEAN in 2014, endovascular mechanical thrombectomy of acute ischemic stroke has seen an upsurge in application, research, and dissemination that few methods in medicine experience. However, new challenges have arisen from this constant development of endovascular stroke treatment. One common challenge is that associated with intracranial vessel occlusion treatment combined with an ipsilateral carotid artery stenosis or occlusion, a so called “tandem lesion” (TL). Many investigators have shown the feasibility and safety of treatment of both lesions in one session with a superiority in terms of thrombolysis-in-cerebral-infarction-(TICI-) scale( 1 ) and clinical outcome as well as a similar rate of adverse events compared with staged treatment( 2 ). However, the risk of stent re-occlusion is high in patients with a treated TL, and anti-platelet therapy (APT) must be carried out carefully since the brain infarction is prone to hemorrhage. Even under careful administration of anti-platelet medication, the risk of stent re-occlusion may be up to 57% in the first 24 h( 3 ). However, sustained stent patency after acute treatment of a TL is associated with improved clinical outcome( 4 – 6 ). Currently, data on the safety of APT in the course of endovascular TL treatment as well as applied drug strategies are inhomogeneous( 7 – 9 ), making consent or recommendation of an anti-thrombotic medical regiment difficult. Furthermore, a recent meta-analysis did not find a significant difference in the use of no APT vs. single APT vs. dual APT as periprocedural platelet managements in TL treatment( 10 ). We therefore examined the stent patency and outcome in 176 consecutive patients at 24 h, discharge and 90 days following TL treatment with a homogeneous drug regimen of triple APT, which we assumed might be superior to the drug regimens described so far. Methods Study Population We analyzed data from all patients at our neurointerventional center who were treated for acute ischemic stroke with intracranial thrombectomy and ipsilateral carotid artery stenting (TL) between 2013 and 2022. To be included in this study, the causes of cervical internal carotid artery (ICA) lesions had to be atherosclerosis or dissection. TL Patients not treated with triple APT as described under " Medication " in the following section were excluded. TL Patients treated with carotis artery stenting (CAS) in the intradural segments of the ICA and vessel status < TICI2b at the end of intervention were excluded. Patients' medical records were analyzed for body mass index, diabetes, previous myocardial infarction, arterial hypertension, and smoking. Patients’ sex and age were recorded, and ICA stenosis grade was classified according to NASCET criteria( 11 ). We further recorded periprocedural data including duration of intervention, time from onset to recanalization, ASPECT score, TICI score, collateral score, use of percutaneous transluminal angioplasty (PTA) after stenting, number of stents deployed, and number of intracranial thrombectomy passes. Medication Preceding ICA stent implantation, all patients received a single body-weight-adjusted intravenous bolus of Eptifibatide (135 mcg/kg body weight; Integrilin, GlaxoSmithKline). In addition, all patients received 500 mg acetylsalicylic acid (ASA; Aspirin i.v. 500 mg, Bayer Vital) intravenously and either 180 mg ticagrelor (Brilique, AstraZeneca), 40 mg prasugrel (Efient, Daiichi Sankyo), or 300 mg clopidogrel (Plavix, Sanofi-Aventis) via a nasogastric tube. For medicinal treatment, 1× 100 mg ASA and 2× 90 mg ticagrelor or 1× 10 mg prasugrel or 1× 75 mg clopidogrel were administered from day 1 after treatment for 1 year. Thereafter 1× 100 mg ASA was prescribed for life. Follow-up All patients received duplex imaging for stent patency at 24h (+/-6h) following treatment, at discharge and 90 days (+/-10d) following treatment. If in-stent thrombosis and/or stenosis were suspected, digital subtraction angiography (DSA) was performed for confirmation. The clinical endpoints within the 90-day follow-up were as follows: - any periprocedural complication resulting in a major hemorrhagic event, major stroke, or death. - mRS at discharge and at 90 days - any mortality related to the CAS procedure - any permanent clinical worsening associated with the CAS procedure - in-stent thrombosis or stenosis detected on duplex imaging, confirmed by DSA - any ipsilateral postprocedural stroke or major hemorrhagic event - any postprocedural complication resulting in a major hemorrhagic event, including symptomatic intracranial hemorrhage (sICH), major stroke, or death. Major hemorrhagic events were defined as hemorrhages requiring an endovascular or surgical intervention or bleeding that lowered hemoglobin levels and required transfusion of red cell concentrate. Severe stroke was defined as a permanent neurological deficit that resulted in a worsening of the modified Rankin Scale (mRS) score by at least one point. All surviving patients underwent neurological examination at discharge and at 90 days using the mRS. Implanted stents were also evaluated sonographically at discharge and at 90 days. If an in-stent stenosis was suspected, patients underwent DSA to exclude or confirm stenosis. Statistical Analysis Descriptive statistics were assessed as mean ± standard deviation for continuous variables and counts and percentages for categorical variables. The exact fisher-test was used to determine the endpoint p -values; the Mann–Whitney U Test was used for multivariate analyses. Also, multivariate analysis used a logistic regression model with stepwise selection. The threshold for statistical significance was set at 5% (0.05). Results Between 2013 and 2022, 3636 intracranial thrombectomies were performed at our institution. In 266 cases, stent-assisted angioplasty of a cervical and/or intracranial vessel connected to the occluded intracranial segment was performed under triple APT in the anterior and posterior circulation and met the “equal or better TICI2b” criterion at the end of the intervention. Among these, 176 consecutive patients received cervical stent-angioplasty and ipsilateral intracranial thrombectomy under triple APT in the anterior circulation and were included in the analysis exclusively. The mean age was 69.1 years, the male gender was dominant at 63.1% ( n = 111). Among the reported comorbidities, i.e., atrial fibrillation, arterial hypertension, coronary heart disease, diabetes mellitus, hyperlipidemia, and current tobacco smoking, arterial hypertension was the most common at 61.9% (Table 1 ). Table 1 Comorbidities of included patients. * Exact Fisher-test mRS 90 d n 3–6 0–2 OR (95%-KI) p-value* pre mRS 0 101 45 (44.6%) 56 (55.4%) - 1 39 23 (59.0%) 16 (41.0%) 0.56 (0.26–1.19) 0.136 2 24 17 (70.8%) 7 (29.2%) 0.33 (0.12–0.89) 0.024 3 12 12 (100%) 0 (0%) - < 0.001 AF no 147 73 (49.7%) 74 (50.3%) yes 29 24 (82.8%) 5 (17.2%) 0.21 (0.07–0.59) 0.001 diabetes no 145 75 (51.7%) 70 (48.3%) yes 31 22 (71.0%) 9 (29.0%) 0.44 (0.19–1.03) 0.072 cholesterol no 149 86 (57.7%) 63 (42.3%) yes 27 11 (40.7%) 16 (59.3%) 1.99 (0.86–4.61) 0.140 hypertension no 67 41 (61.2%) 26 (38.8%) yes 109 56 (51.4%) 53 (48.6%) 1.49 (0.80–2.78) 0.216 current tobacco smoking no 138 77 (55.8%) 61 (44.2%) yes 38 20 (52.6%) 18 (47.4%) 1.14 (0.55–2.34) 0.854 cardiac disease no 132 62 (47.0%) 70 (53.0%) yes 44 35 (79.5%) 9 (20.5%) 0.23 (0.10–0.53) < 0.001 amount of comorbidities 0 21 13 (61.9%) 8 (38.1%) (AF-cardiac disease) 1 49 22 (44.9%) 27 (55.1%) 2 56 31 (55.4%) 25 (44.6%) 3 32 19 (59.4%) 13 (40.6%) 4 13 8 (61.5%) 5 (38.5%) 5 3 2 (66.7%) 1 (33.3%) 6 2 2 (100%) 0 (0%) The side distribution of occluded ICAs was almost equal with 89 occlusions of the left ICA vs. 87 right-sided ICA. The cause of vessel stenosis or occlusion was atherosclerotic disease in 96.6% of cases and dissection in 3.4%. The degree of stenosis was 95% at mean (60–100%) following NASCET, and there were 30.7% complete occlusions. The mean NIHSS score at presentation was 13.2. When comparing the mRS score at hospital admission with the "last seen well" score, the treated patients had suffered an average worsening of 3.64 points due to acute ischemic stroke leading to presentation at our department. 33% of patients received intravenous thrombolysis before MT. The mean time from onset to puncture was 302.1 min, the mean time from puncture to recanalization TICI2b was 92.3 min. Please refer to Appendix for further details. 24 patients/13.7% died during the in-hospital phase, n = 7/4% of whom were directly connected to endovascular treatment (3 patients died of sICH following treatment, 4 patients died due to reperfusion syndrome, two of them with sICH). No patients showed restenosis or occlusion of the extracranial ICA at 24 h, and 8 patients (4.5%) showed a restenosis or occlusion 90 days after the intervention. There was no significant influence of one of any of the reported comorbidities on restenosis or re-occlusion, and there was no significant risk elevation in patients suffering from two or more of the reported comorbidities (Table 2 ). Table 2 Comorbidities in relation to re-stenosis at 90 days. * Exact Fisher-Test Restenosis n no yes OR (95%-KI) p-value* AF no 147 140 (95.2%) 7 (4.8%) yes 29 28 (96.6%) 1 (3.4%) 0.71 (0.08–6.08) 1.000 diabetes no 145 138 (95.2%) 7 (4.8%) yes 31 30 (96.8%) 1 (3.2%) 0.66 (0.08–5.58) 1.000 cholesterol no 149 141 (94.6%) 8 (5.4%) yes 27 27 (100%) 0 (0%) 0.610 hypertension no 67 65 (97.0%) 2 (3.0%) yes 109 103 (94.5%) 6 (5.5%) 1.89 (0.37–9.74) 0.712 smoker no 138 134 (97.1%) 4 (2.9%) yes 38 34 (89.5%) 4 (10.5%) 3.94 (0.92–16.92) 0.067 cardiac disease no 132 125 (94.7%) 7 (5.3%) yes 44 43 (97.7%) 1 (2.3%) 0.42 (0.05–3.51) 0.681 Amount of comorbiditis 0 21 21 (100%) 0 (0%) (AF-cardiac disease) 1 49 47 (95.9%) 2 (4.1%) 2 56 52 (92.9%) 4 (7.1%) 3 32 30 (93.8%) 2 (6.2%) 4 13 13 (100%) 0 (0%) 5 3 3 (100%) 0 (0%) 6 2 2 (100%) 0 (0%) 90 day mRS 0 24 23 (95.8%) 1 (4.2%) 1 33 30 (90.9%) 3 (9.1%) 2 22 21 (95.5%) 1 (4.5%) 3 23 20 (87.0%) 3 (13.0%) 4 32 32 (100%) 0 (0%) 5 11 11 (100%) 0 (0%) 6 31 31 (100%) 0 (0%) 44.9% of the patients had a mRS score of 0–2 at the 90-day follow-up, 86.4% of the patients maintained (40.9%) or improved (45.5%) their discharge mRS score by follow up at 90 days. Improving patients had a mean reduction in mRS score of 1.7 points. Atrial fibrillation and coronary heart disease showed a significant connection with mRS 3–6 at 90 days (Table 3 ). Table 3 comorbidities in relation to mRS score at 90 days. * exact Fisher-test mRS 90 d n 3–6 0–2 OR (95%-KI) p-value* pre mRS 0 101 45 (44.6%) 56 (55.4%) - 1 39 23 (59.0%) 16 (41.0%) 0.56 (0.26–1.19) 0.136 2 24 17 (70.8%) 7 (29.2%) 0.33 (0.12–0.89) 0.024 3 12 12 (100%) 0 (0%) - < 0.001 AF no 147 73 (49.7%) 74 (50.3%) yes 29 24 (82.8%) 5 (17.2%) 0.21 (0.07–0.59) 0.001 diabetes no 145 75 (51.7%) 70 (48.3%) yes 31 22 (71.0%) 9 (29.0%) 0.44 (0.19–1.03) 0.072 cholesterol no 149 86 (57.7%) 63 (42.3%) yes 27 11 (40.7%) 16 (59.3%) 1.99 (0.86–4.61) 0.140 hypertension no 67 41 (61.2%) 26 (38.8%) yes 109 56 (51.4%) 53 (48.6%) 1.49 (0.80–2.78) 0.216 current tobacco smoking no 138 77 (55.8%) 61 (44.2%) yes 38 20 (52.6%) 18 (47.4%) 1.14 (0.55–2.34) 0.854 cardiac disease no 132 62 (47.0%) 70 (53.0%) yes 44 35 (79.5%) 9 (20.5%) 0.23 (0.10–0.53) < 0.001 Amount of comorbidities 0 21 13 (61.9%) 8 (38.1%) (AF-cardiac disease) 1 49 22 (44.9%) 27 (55.1%) 2 56 31 (55.4%) 25 (44.6%) 3 32 19 (59.4%) 13 (40.6%) 4 13 8 (61.5%) 5 (38.5%) 5 3 2 (66.7%) 1 (33.3%) 6 2 2 (100%) 0 (0%) Furthermore, the duration of intervention and the number of comorbidities did not significantly influence the mRS score at 90 days. However, a high NIHSS at presentation was connected to a mRS score of 3–6 at 90 days (Table 4 ). Table 4 Duration of intervention, NIHSS at presentation, and amount of comorbidities in relation to mRS at 90 days. * Mann-Whitney-U-Test. mRS90 d n Mv Sd Median Min-Max p-value* OR (95%-KI) Puncture time to 3–6 97 97.3 59.2 79.0 27.0-285.0 0.227 recanalisation in min 0–2 79 86.8 54.4 68.0 32.0-311.0 1.00 (0.99-1.00) NIHSS (Score) 3–6 94 15.6 6.5 17.0 0.0–27.0 < 0.001 0–2 77 10.2 6.5 10.0 0.0–25.0 0.89 (0.86–0.93) Amount of comorbidities 3–6 97 2.0 1.4 2.0 0.0–6.0 0.285 0–2 79 1.8 1.1 2.0 0.0–5.0 0.87 (0.68–1.10) In the logistic regression (stepwise selection) as multivariate analysis, again only a high NIHSS at presentation showed a significant influence of the mRS at 90 days (Table 5 ). Table 5 mRS 90 d - multivariate analysis (logistic regression); n = 171 stepwise selection (p < 0.05) pre mRS 1 vs 0 0.76 (0.29 ; 1.97), p = 0.566 pre mRS 2–3 vs 0 0.30 (0.11 ; 0.86), p = 0.024 AF 0.22 (0.07 ; 0.68), p = 0.009 diabetes - cholesterol 3.71 (1.23 ; 11.22), p = 0.020 hypertension - Current tobacco smoking - cardiac disease 0.35 (0.15 ; 0.85), p = 0.021 Puncture time to recan. (min) - NIHSS 0.88 (0.83 ; 0.93), p < 0.001 Discussion This study focused on the outcomes for patients undergoing acute TL treatment under triple APT and analysis of the stent patency and outcome 24 h and 90 days after the procedure. Extracranial stent patency at 24 h correlates with a better clinical outcome, and intravenous thrombolytic therapy accompanying thrombectomy was found to have a positive influence on stent patency. Recent studies advocate an aggressive APT in the initial phase to keep the stent open( 6 , 12 , 13 ). The reported rates of restenosis or non-patency of the ICA after TL treatment at 24 h was reported to be 20.9%( 14 ) in a recent large-volume multicenter analysis covering 225 patients; 22%( 15 ) in a recent single-center analysis covering 99 patients with TL treatment through CAS; 55.4% in a single-center retrospective study covering 83 comparable patients( 6 ); and 56.9% in an analysis of two multicenter international observational registries covering 65 patients with comparable TL treatment( 3 ). Among the patients included in this study, 33% ( n = 58) received intravenous thrombolysis. However, stent patency at 24 h was 100% in our study, and there was no significant influence of thrombolysis on the patency of the stent for the extracranial carotid artery (Table 6 ; Appendix). Table 6 Comparison of preceding major case studies. Abbreviations: Cyclooxygenase Inhibitor - COXI; Glycoprotein IIb/IIIa inhibitor - GP-IIb/IIIa-I; P2Y12-antagnosit P2Y12. * Authors do not differentiate symptomatic and any intracerebral hematoma. Author (year) N ICA re-occlusion at 24h sICH mRS 0–2 at 90d APT Allard et al. (2023)(14) 225 20.9% n.a.* 54.7% COXI and P2Y12 or GP-IIb/IIIa-I Renú et al. (2020)(15) 99 22% 4% 66.7% COXI and P2Y12 Bricout et al. (2018)(6) 83 55.4% 12.1% 41% COXI Marnat et al. (2020)(3) 65 56.9% 10.8% 54% n.a. Data in this study 176 0% 2.3% 45% COXI and P2Y12 and GP-IIb/IIIa-I The rate of extracranial ICA restenosis after 90 days in this study was 4.5% ( n = 8). In this small case number, no influencing factor of significance could be identified. The number of patients with a mRS score of 0–2 at day 90 was within the range of published data, albeit in the lower section. The comparably low rate may be caused by the fact that patients included in this study had a long time from onset/last seen well to puncture (mean 302 minutes, range 66-3014 minutes). Despite the fact that patients in our study had the most aggressive APT, the rate of sICH was the lowest within the mentioned studies (Table 6 ). In contrast to a hyperperfusion syndrome as the cause for sICH, requiring patency of the formerly occluded or stenotic ipsilateral ICA, sICH following TL treatment may be more frequent in patients with stent-/ICA-reocclusion 5 . Furthermore, the development of sICH is highly dependent on the postinterventional management of systolic blood pressure, which may be underreported in previous studies. However, data on factors influencing the development of sICH following TL treatment are too few, and also, in this study, no factor of significant influence could be identified. Still, in concordance with previously published data, the mortality of patients suffering from sICH is high at 50% in this study. Furthermore, in accordance with previous reports( 12 ), the correlation between NIHSS and a 90-day mRS score of 3–6 was found to be significant in our data. A direct proportionality between time of intervention, number of recanalization attempts, and futile recanalization attempts on a negative, unfavorable outcome is well described for thrombectomy( 16 ). This however accounts for non-tandem, solitary lesions in the anterior circulation. Therefore, a question we wanted to investigate with our data was whether in the often-complex treatment of tandem lesions, supposedly originating from a chronic ICA stenosis, there is a point in intervention after which the chance of reversing stroke is overweighed by the risk of harming the patient, i.e., a time to stop. However, regarding the 90-day mRS scores, there was no significant influence of the time from groin puncture to recanalization. At a mean time of 92 minutes from groin puncture to recanalization TICI2b, the mean interventional treatment time was longer than treating an intracranial vessel occlusion alone, and nearly twice as long as in a 2016 meta-analysis on thrombectomy covering 1287 patients( 17 ). In this meta-analysis, a longer time to reperfusion was found to increase the risk of a worse outcome, congruent with other more recent studies on thrombectomy in purely intracranial vessel occlusion( 13 , 18 , 19 ). However, even in the group of patients undergoing interventional treatment with puncture-to-recanalization times beyond 120 min in our study ( n = 44; 25%), only 3 patients/6.8% (1.7% in total) did not maintain or improve their discharge mRS at 90 days, but fell by one score point each. The rate of in-hospital death in this subgroup was higher with n = 7/15.9% vs. n = 17/12.88% in the group of patients having endovascular procedures shorter than 120 min. However, all 7 patients with in-hospital death in the group with time-to-reperfusion beyond 120 min arrived at the hospital with a higher NIHSS (mean 14 [9–24] vs. 13 [14–27]) and had a longer time of onset to puncture (mean 366.7 min [196–622 min] vs. mean 302.16 min [66–871 min]). The latter two factors, known to have a negative effect on outcome, may be an explanation for the slightly higher in-hospital mortality rate in the group with the longer time from puncture to recanalization. Nevertheless, the cause of death was connected to the infarction in only 3 of the 7 patients in this study. However, a lack of association between the timing of puncture and recanalization in TL could be explained by the fact that most TL patients probably had chronic moderate- to high-grade stenosis of the extracranial portion of the carotid artery that preceded the occlusion leading to clinical presentation. In such a setting, the brain may have already developed collateralization to cope with the chronically reduced blood flow, resulting in less severe cut of blood supply upon vessel occlusion. The number of patients with in-hospital death who had more than 3 attempts of intracranial thrombectomy is however high at 27.3% (6/22). 36.4%/ n = 8 patients did not show improved mRS scored at discharge in this subgroup of patients, while only 27.3%/6 patients improved. This finding is concordant with the results of a major stroke registry analysis describing the odds for a favorable outcome of mechanical thrombectomy as the highest for patients with a maximum of 3 intracranial retrieval attempts( 16 ). Conclusion In TL treatment with triple APT, the rate of patent vessels in this data was higher than published data for dual or single APT at a comparable rate of favorable mRS at 90 days, but at a lower rate of sICH. Also, the restenosis rate after 90 days was low with triple APT. This suggests that an initially aggressive APT may be critical for stent patency and may not influence the rate of sICH. However, more data are needed to confirm this hypothesis. In addition, there is no relationship between the duration of the procedure and outcome in our data, suggesting that even if the procedure is laborious and difficult, revascularization should be pursued, as it can be a worthwhile endeavor. Abbreviations APT Anti-platelet therapy ASA Acetyl-salicylic acid CAS Carotid artery stenting DSA Digital subtraction angiography ICA Internal carotid artery mRS Modified ranking scale PTA Percutaneous transluminal angioplasty sICH Symptomatic intracranial hematoma TICI Thrombolysis in cerebral infarction TL Tandem lesion Declarations Ethics approval and consent to participate This single-center retrospective analysis was conducted in accordance with the Declaration of Helsinki and approved by the local ethics committee (Ärztekammer Nord-Württemberg, Stuttgart, Germany IRB number: F-2012-077). Informed consent to participate in the study and to the publication of the data was obtained from all subjects. Funding and disclosure of potential conflict of interests/competing interests No funds or grants were provided for this work. H. Henkes: Consulting and proctoring for phenox GmbH, co-owner of CONTARA GmbH. The authors declare that they have no further potential conflicts of interest. Concerning the authors This work complies with all instructions to authors. Authorship requirements have been met and the final manuscript was approved for publication by all authors. Concerning publishing This manuscript has not been published elsewhere and is not under consideration by another journal. Data and results described in this manuscript have not been presented elsewhere. Author’s contributions A. Khanafer, H. Henkes and P. von Gottberg conceived the manuscript. A. Khanafer has collected the data. A. Khanafer, P. Bücke, F. Hennersdorf and H. Bäzner evaluated the data. A. Khanafer and P. von Gottberg wrote the manuscript. H. Henkes, M. Forsting and H. Bäzner advised on reference selection. H. Henkes, M. Forsting and H. Bäzner proofread the manuscript. Availability of data and materials All data generated or analyzed during this study are included in this published article (and its supplementary information files). References Higashida RT, Furlan AJ. Trial Design and Reporting Standards for Intra-Arterial Cerebral Thrombolysis for Acute Ischemic Stroke. Stroke [Internet]. 2003 Aug [cited 2023 Aug 8];34(8). Available from: https://www.ahajournals.org/doi/10.1161/01.STR.0000082721.62796.09 Zhu F, Bracard S, Anxionnat R, Derelle AL, Tonnelet R, Liao L, et al. Impact of Emergent Cervical Carotid Stenting in Tandem Occlusion Strokes Treated by Thrombectomy: A Review of the TITAN Collaboration. Front Neurol. 2019 Mar 11;10:206. Marnat G, Lapergue B, Sibon I, Gariel F, Bourcier R, Kyheng M, et al. Safety and Outcome of Carotid Dissection Stenting During the Treatment of Tandem Occlusions: A Pooled Analysis of TITAN and ETIS. Stroke. 2020 Dec;51(12):3713–8. Pop R, Zinchenko I, Quenardelle V, Mihoc D, Manisor M, Richter JS, et al. Predictors and Clinical Impact of Delayed Stent Thrombosis after Thrombectomy for Acute Stroke with Tandem Lesions. Am J Neuroradiol. 2019 Feb 14;ajnr;ajnr.A5976v1. Anadani M, Spiotta AM, Alawieh A, Turjman F, Piotin M, Haussen DC, et al. Emergent Carotid Stenting Plus Thrombectomy After Thrombolysis in Tandem Strokes: Analysis of the TITAN Registry. Stroke. 2019 Aug;50(8):2250–2. Bricout N, Personnic T, Ferrigno M, Labreuche J, Estrade L, Bretzner M, et al. Day 1 Extracranial Internal Carotid Artery Patency Is Associated With Good Outcome After Mechanical Thrombectomy for Tandem Occlusion. Stroke. 2018 Oct;49(10):2520–2. Rana A, Yu S, Reid-Herrera S, Kamen S, Hunter K, Shaikh H, et al. Eptifibatide use in ischemic stroke patients undergoing endovascular thrombectomy: A matched cohort analysis. Front Neurol. 2022 Sep 27;13:939215. Jost A, Roels C, Brown M, Janjua R, Heck D. Low-Dose Eptifibatide for Tandem Occlusion in Stroke: Safety and Carotid Artery Patency. Am J Neuroradiol. 2021 Apr;42(4):738–42. Osteraas ND, Crowley RW, Panos N, Dafer RM. Eptifibatide use following emergent carotid stenting in acute anterior circulation ischemic stroke with tandem occlusion. J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105021. Diana F, Abdalkader M, Behme D, Li W, Maurer CJ, Pop R, et al. Antithrombotic regimen in emergent carotid stenting for acute ischemic stroke due to tandem occlusion: a meta-analysis of aggregate data. J NeuroInterventional Surg. 2023 Apr 25;jnis-2023-020204. Beneficial Effect of Carotid Endarterectomy in Symptomatic Patients with High-Grade Carotid Stenosis. N Engl J Med. 1991 Aug 15;325(7):445–53. Park JS, Lee JM, Kwak HS, Chung GH. Endovascular treatment of acute carotid atherosclerotic tandem occlusions: Predictors of clinical outcomes as technical aspects and location of tandem occlusions. J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105090. Pu M, Chen J, Chen Z, Li Z, Li Z, Tang Y, et al. Predictors and outcome of malignant cerebral edema after successful reperfusion in anterior circulation stroke. J Stroke Cerebrovasc Dis. 2023 Jun;32(6):107139. Allard J, Delvoye F, Pop R, Labreuche J, Maier B, Marnat G, et al. 24-Hour Carotid Stent Patency and Outcomes After Endovascular Therapy: A Multicenter Study. Stroke. 2023 Jan;54(1):124–31. Renú A, Blasco J, Laredo C, Llull L, Urra X, Obach V, et al. Carotid stent occlusion after emergent stenting in acute ischemic stroke: Incidence, predictors and clinical relevance. Atherosclerosis. 2020 Nov;313:8–13. Flottmann F, Brekenfeld C, Broocks G, Leischner H, McDonough R, Faizy TD, et al. Good Clinical Outcome Decreases With Number of Retrieval Attempts in Stroke Thrombectomy: Beyond the First-Pass Effect. Stroke. 2021 Feb;52(2):482–90. Saver JL, Goyal M, Van Der Lugt A, Menon BK, Majoie CBLM, Dippel DW, et al. Time to Treatment With Endovascular Thrombectomy and Outcomes From Ischemic Stroke: A Meta-analysis. JAMA. 2016 Sep 27;316(12):1279. Cappellari M, Saia V, Pracucci G, Fainardi E, Casetta I, Sallustio F, et al. Predictors for clinical and functional outcomes in stroke patients with first‐pass complete recanalization after thrombectomy. Eur J Neurol. 2023 May 9;ene.15842. Desai S, Aghaebrahim AN, Siegler JE, Monteiro A, Jadhav AP, Jovin TG. Abstract P481: Time to Reperfusion Determines Clinical Outcomes Independent of Post Thrombectomy Infarct Volume. Stroke [Internet]. 2021 Mar [cited 2023 May 19];52(Suppl_1). Available from: https://www.ahajournals.org/doi/10.1161/str.52.suppl_1.P481 Additional Declarations No competing interests reported. Supplementary Files AppendixIntegrilintandemanterior.xlsx Cite Share Download PDF Status: Published Journal Publication published 18 Mar, 2024 Read the published version in BMC Neurology → Version 1 posted Editorial decision: Revision requested 02 Feb, 2024 Reviews received at journal 01 Feb, 2024 Reviews received at journal 22 Jan, 2024 Reviewers agreed at journal 22 Jan, 2024 Reviewers agreed at journal 21 Jan, 2024 Reviewers invited by journal 21 Jan, 2024 Editor invited by journal 16 Jan, 2024 Editor assigned by journal 15 Jan, 2024 Submission checks completed at journal 15 Jan, 2024 First submitted to journal 09 Jan, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3848031","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":267491462,"identity":"afc37a36-df10-419c-99e9-b19113b8eb9b","order_by":0,"name":"Ali Khanafer","email":"","orcid":"","institution":"Neuroradiological Clinic, Neurozentrum, Klinikum Stuttgart, Stuttgart","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ali","middleName":"","lastName":"Khanafer","suffix":""},{"id":267491463,"identity":"4f4f2c3f-b901-4e28-aa8b-a764147bbe23","order_by":1,"name":"Hans Henkes","email":"","orcid":"","institution":"Neuroradiological Clinic, Neurozentrum, Klinikum Stuttgart, Stuttgart","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hans","middleName":"","lastName":"Henkes","suffix":""},{"id":267491464,"identity":"6146daae-1d1a-430a-91fe-4e88a2b4c337","order_by":2,"name":"Philipp Bücke","email":"","orcid":"","institution":"Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Philipp","middleName":"","lastName":"Bücke","suffix":""},{"id":267491465,"identity":"ddc51ec1-fc3c-49b8-ae09-c0420054410f","order_by":3,"name":"Florian Hennersdorf","email":"","orcid":"","institution":"Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Tübingen","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Florian","middleName":"","lastName":"Hennersdorf","suffix":""},{"id":267491466,"identity":"eda09236-662e-4d81-96ba-07007e6de31b","order_by":4,"name":"Hansjörg Bäzner","email":"","orcid":"","institution":"Neurological Clinic, Neurozentrum, Klinikum Stuttgart, Stuttgart","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hansjörg","middleName":"","lastName":"Bäzner","suffix":""},{"id":267491467,"identity":"d10a1440-1d1b-4405-a375-a3f47a8676d5","order_by":5,"name":"Michael Forsting","email":"","orcid":"","institution":"Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Michael","middleName":"","lastName":"Forsting","suffix":""},{"id":267491468,"identity":"c7ba325c-d195-4dba-9e21-5e2ab7d8d422","order_by":6,"name":"Philipp von Gottberg","email":"data:image/png;base64,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","orcid":"","institution":"Neuroradiological Clinic, Neurozentrum, Klinikum Stuttgart, Stuttgart","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Philipp","middleName":"","lastName":"von Gottberg","suffix":""}],"badges":[],"createdAt":"2024-01-09 11:14:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3848031/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3848031/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12883-024-03597-0","type":"published","date":"2024-03-18T15:02:55+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":53403901,"identity":"c15388d3-ae37-4c7b-9ef3-1beb0ab81450","added_by":"auto","created_at":"2024-03-25 15:16:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":285321,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3848031/v1/6d9cc0cb-a739-4d69-a463-7923b9ad71fd.pdf"},{"id":49735121,"identity":"92337e87-c43d-4f5a-8488-d58015274224","added_by":"auto","created_at":"2024-01-17 07:16:10","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":47812,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixIntegrilintandemanterior.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-3848031/v1/040600e87c20021b2a4e28d2.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eTriple Platelet Inhibition in Intracranial Thrombectomy with Additional Acute Cervical Stent Angioplasty due to Tandem Lesion: A retrospective single-center analysis\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eSince the publication of the trial data by MR CLEAN in 2014, endovascular mechanical thrombectomy of acute ischemic stroke has seen an upsurge in application, research, and dissemination that few methods in medicine experience.\u003c/p\u003e \u003cp\u003eHowever, new challenges have arisen from this constant development of endovascular stroke treatment. One common challenge is that associated with intracranial vessel occlusion treatment combined with an ipsilateral carotid artery stenosis or occlusion, a so called \u0026ldquo;tandem lesion\u0026rdquo; (TL). Many investigators have shown the feasibility and safety of treatment of both lesions in one session with a superiority in terms of thrombolysis-in-cerebral-infarction-(TICI-) scale(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) and clinical outcome as well as a similar rate of adverse events compared with staged treatment(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, the risk of stent re-occlusion is high in patients with a treated TL, and anti-platelet therapy (APT) must be carried out carefully since the brain infarction is prone to hemorrhage. Even under careful administration of anti-platelet medication, the risk of stent re-occlusion may be up to 57% in the first 24 h(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). However, sustained stent patency after acute treatment of a TL is associated with improved clinical outcome(\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCurrently, data on the safety of APT in the course of endovascular TL treatment as well as applied drug strategies are inhomogeneous(\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), making consent or recommendation of an anti-thrombotic medical regiment difficult. Furthermore, a recent meta-analysis did not find a significant difference in the use of no APT vs. single APT vs. dual APT as periprocedural platelet managements in TL treatment(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWe therefore examined the stent patency and outcome in 176 consecutive patients at 24 h, discharge and 90 days following TL treatment with a homogeneous drug regimen of triple APT, which we assumed might be superior to the drug regimens described so far.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Population\u003c/h2\u003e \u003cp\u003eWe analyzed data from all patients at our neurointerventional center who were treated for acute ischemic stroke with intracranial thrombectomy and ipsilateral carotid artery stenting (TL) between 2013 and 2022. To be included in this study, the causes of cervical internal carotid artery (ICA) lesions had to be atherosclerosis or dissection. TL Patients not treated with triple APT as described under \"\u003cem\u003eMedication\u003c/em\u003e\" in the following section were excluded. TL Patients treated with carotis artery stenting (CAS) in the intradural segments of the ICA and vessel status\u0026thinsp;\u0026lt;\u0026thinsp;TICI2b at the end of intervention were excluded.\u003c/p\u003e \u003cp\u003ePatients' medical records were analyzed for body mass index, diabetes, previous myocardial infarction, arterial hypertension, and smoking. Patients\u0026rsquo; sex and age were recorded, and ICA stenosis grade was classified according to NASCET criteria(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). We further recorded periprocedural data including duration of intervention, time from onset to recanalization, ASPECT score, TICI score, collateral score, use of percutaneous transluminal angioplasty (PTA) after stenting, number of stents deployed, and number of intracranial thrombectomy passes.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMedication\u003c/h3\u003e\n\u003cp\u003ePreceding ICA stent implantation, all patients received a single body-weight-adjusted intravenous bolus of Eptifibatide (135 mcg/kg body weight; Integrilin, GlaxoSmithKline). In addition, all patients received 500 mg acetylsalicylic acid (ASA; Aspirin i.v. 500 mg, Bayer Vital) intravenously and either 180 mg ticagrelor (Brilique, AstraZeneca), 40 mg prasugrel (Efient, Daiichi Sankyo), or 300 mg clopidogrel (Plavix, Sanofi-Aventis) via a nasogastric tube.\u003c/p\u003e\n\u003cp\u003eFor medicinal treatment, 1\u0026times; 100 mg ASA and 2\u0026times; 90 mg ticagrelor or 1\u0026times; 10 mg prasugrel or 1\u0026times; 75 mg clopidogrel were administered from day 1 after treatment for 1 year. Thereafter 1\u0026times; 100 mg ASA was prescribed for life.\u003c/p\u003e\n\u003cdiv id=\"Sec5\"\u003e\n \u003ch2\u003eFollow-up\u003c/h2\u003e\n \u003cp\u003eAll patients received duplex imaging for stent patency at 24h (+/-6h) following treatment, at discharge and 90 days (+/-10d) following treatment. If in-stent thrombosis and/or stenosis were suspected, digital subtraction angiography (DSA) was performed for confirmation.\u003c/p\u003e\n \u003cp\u003eThe clinical endpoints within the 90-day follow-up were as follows:\u003c/p\u003e\n \u003cp\u003e- any periprocedural complication resulting in a major hemorrhagic event, major stroke, or death.\u003c/p\u003e\n \u003cp\u003e- mRS at discharge and at 90 days\u003c/p\u003e\n \u003cp\u003e- any mortality related to the CAS procedure\u003c/p\u003e\n \u003cp\u003e- any permanent clinical worsening associated with the CAS procedure\u003c/p\u003e\n \u003cp\u003e- in-stent thrombosis or stenosis detected on duplex imaging, confirmed by DSA\u003c/p\u003e\n \u003cp\u003e- any ipsilateral postprocedural stroke or major hemorrhagic event\u003c/p\u003e\n \u003cp\u003e- any postprocedural complication resulting in a major hemorrhagic event, including symptomatic intracranial hemorrhage (sICH), major stroke, or death.\u003c/p\u003e\n \u003cp\u003eMajor hemorrhagic events were defined as hemorrhages requiring an endovascular or surgical intervention or bleeding that lowered hemoglobin levels and required transfusion of red cell concentrate. Severe stroke was defined as a permanent neurological deficit that resulted in a worsening of the modified Rankin Scale (mRS) score by at least one point.\u003c/p\u003e\n \u003cp\u003eAll surviving patients underwent neurological examination at discharge and at 90 days using the mRS. Implanted stents were also evaluated sonographically at discharge and at 90 days. If an in-stent stenosis was suspected, patients underwent DSA to exclude or confirm stenosis.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\"\u003e\n \u003ch2\u003eStatistical Analysis\u003c/h2\u003e\n \u003cp\u003eDescriptive statistics were assessed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation for continuous variables and counts and percentages for categorical variables. The exact fisher-test was used to determine the endpoint \u003cem\u003ep\u003c/em\u003e-values; the Mann\u0026ndash;Whitney U Test was used for multivariate analyses. Also, multivariate analysis used a logistic regression model with stepwise selection. The threshold for statistical significance was set at 5% (0.05).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eBetween 2013 and 2022, 3636 intracranial thrombectomies were performed at our institution. In 266 cases, stent-assisted angioplasty of a cervical and/or intracranial vessel connected to the occluded intracranial segment was performed under triple APT in the anterior and posterior circulation and met the \u0026ldquo;equal or better TICI2b\u0026rdquo; criterion at the end of the intervention. Among these, 176 consecutive patients received cervical stent-angioplasty and ipsilateral intracranial thrombectomy under triple APT in the anterior circulation and were included in the analysis exclusively. The mean age was 69.1 years, the male gender was dominant at 63.1% (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;111). Among the reported comorbidities, i.e., atrial fibrillation, arterial hypertension, coronary heart disease, diabetes mellitus, hyperlipidemia, and current tobacco smoking, arterial hypertension was the most common at 61.9% (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComorbidities of included patients. * Exact Fisher-test\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003emRS 90 d\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c7\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u0026ndash;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOR (95%-KI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep-value*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epre mRS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45 (44.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e56 (55.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (59.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16 (41.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.56 (0.26\u0026ndash;1.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.136\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (70.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (29.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.33 (0.12\u0026ndash;0.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73 (49.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e74 (50.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (82.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (17.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.21 (0.07\u0026ndash;0.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ediabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75 (51.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70 (48.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (71.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (29.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.44 (0.19\u0026ndash;1.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003echolesterol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86 (57.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e63 (42.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (40.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16 (59.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.99 (0.86\u0026ndash;4.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.140\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41 (61.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26 (38.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56 (51.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e53 (48.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.49 (0.80\u0026ndash;2.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.216\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecurrent tobacco smoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77 (55.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61 (44.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (52.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18 (47.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.14 (0.55\u0026ndash;2.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.854\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecardiac disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62 (47.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70 (53.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35 (79.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (20.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.23 (0.10\u0026ndash;0.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eamount of comorbidities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (61.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (38.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(AF-cardiac disease)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (44.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27 (55.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31 (55.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25 (44.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (59.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13 (40.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (61.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (38.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe side distribution of occluded ICAs was almost equal with 89 occlusions of the left ICA vs. 87 right-sided ICA. The cause of vessel stenosis or occlusion was atherosclerotic disease in 96.6% of cases and dissection in 3.4%. The degree of stenosis was 95% at mean (60\u0026ndash;100%) following NASCET, and there were 30.7% complete occlusions.\u003c/p\u003e \u003cp\u003eThe mean NIHSS score at presentation was 13.2. When comparing the mRS score at hospital admission with the \"last seen well\" score, the treated patients had suffered an average worsening of 3.64 points due to acute ischemic stroke leading to presentation at our department. 33% of patients received intravenous thrombolysis before MT. The mean time from onset to puncture was 302.1 min, the mean time from puncture to recanalization TICI2b was 92.3 min. Please refer to Appendix for further details.\u003c/p\u003e \u003cp\u003e24 patients/13.7% died during the in-hospital phase, n\u0026thinsp;=\u0026thinsp;7/4% of whom were directly connected to endovascular treatment (3 patients died of sICH following treatment, 4 patients died due to reperfusion syndrome, two of them with sICH). No patients showed restenosis or occlusion of the extracranial ICA at 24 h, and 8 patients (4.5%) showed a restenosis or occlusion 90 days after the intervention. There was no significant influence of one of any of the reported comorbidities on restenosis or re-occlusion, and there was no significant risk elevation in patients suffering from two or more of the reported comorbidities (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComorbidities in relation to re-stenosis at 90 days. * Exact Fisher-Test\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eRestenosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOR (95%-KI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep-value*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e140 (95.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (4.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (96.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.71 (0.08\u0026ndash;6.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ediabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e138 (95.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (4.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (96.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (3.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.66 (0.08\u0026ndash;5.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003echolesterol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e141 (94.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (5.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.610\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65 (97.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (3.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e103 (94.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (5.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.89 (0.37\u0026ndash;9.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.712\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esmoker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e134 (97.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (89.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (10.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.94 (0.92\u0026ndash;16.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.067\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecardiac disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e125 (94.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (5.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43 (97.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.42 (0.05\u0026ndash;3.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.681\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmount of comorbiditis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(AF-cardiac disease)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47 (95.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (4.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52 (92.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (7.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (93.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (6.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e90 day mRS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (95.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (90.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (9.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (95.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (4.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (87.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (13.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e44.9% of the patients had a mRS score of 0\u0026ndash;2 at the 90-day follow-up, 86.4% of the patients maintained (40.9%) or improved (45.5%) their discharge mRS score by follow up at 90 days. Improving patients had a mean reduction in mRS score of 1.7 points. Atrial fibrillation and coronary heart disease showed a significant connection with mRS 3\u0026ndash;6 at 90 days (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ecomorbidities in relation to mRS score at 90 days. * exact Fisher-test\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003emRS 90 d\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u0026ndash;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOR (95%-KI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep-value*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epre mRS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45 (44.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e56 (55.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (59.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16 (41.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.56 (0.26\u0026ndash;1.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.136\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (70.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (29.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.33 (0.12\u0026ndash;0.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73 (49.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e74 (50.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (82.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (17.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.21 (0.07\u0026ndash;0.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ediabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75 (51.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70 (48.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (71.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (29.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.44 (0.19\u0026ndash;1.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003echolesterol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86 (57.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e63 (42.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (40.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16 (59.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.99 (0.86\u0026ndash;4.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.140\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41 (61.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26 (38.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56 (51.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e53 (48.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.49 (0.80\u0026ndash;2.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.216\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecurrent tobacco smoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77 (55.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61 (44.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (52.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18 (47.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.14 (0.55\u0026ndash;2.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.854\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecardiac disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62 (47.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70 (53.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35 (79.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (20.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.23 (0.10\u0026ndash;0.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmount of comorbidities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (61.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (38.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(AF-cardiac disease)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (44.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27 (55.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31 (55.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25 (44.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (59.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13 (40.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (61.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (38.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFurthermore, the duration of intervention and the number of comorbidities did not significantly influence the mRS score at 90 days. However, a high NIHSS at presentation was connected to a mRS score of 3\u0026ndash;6 at 90 days (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDuration of intervention, NIHSS at presentation, and amount of comorbidities in relation to mRS at 90 days. * Mann-Whitney-U-Test.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003emRS90 d\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMv\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSd\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMin-Max\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep-value*\u003c/p\u003e \u003cp\u003eOR (95%-KI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePuncture time to\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026ndash;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e97.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e59.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e79.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e27.0-285.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.227\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003erecanalisation in min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e86.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e54.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e68.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e32.0-311.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.00 (0.99-1.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNIHSS (Score)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026ndash;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e17.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0\u0026ndash;27.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0\u0026ndash;25.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.89 (0.86\u0026ndash;0.93)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmount of comorbidities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026ndash;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0\u0026ndash;6.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.285\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0\u0026ndash;5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.87 (0.68\u0026ndash;1.10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the logistic regression (stepwise selection) as multivariate analysis, again only a high NIHSS at presentation showed a significant influence of the mRS at 90 days (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003emRS 90 d - multivariate analysis (logistic regression); n\u0026thinsp;=\u0026thinsp;171\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003estepwise selection\u003c/p\u003e \u003cp\u003e(p\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epre mRS 1 vs 0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.76 (0.29 ; 1.97), p\u0026thinsp;=\u0026thinsp;0.566\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epre mRS 2\u0026ndash;3 vs 0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.30 (0.11 ; 0.86), p\u0026thinsp;=\u0026thinsp;0.024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.22 (0.07 ; 0.68), p\u0026thinsp;=\u0026thinsp;0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ediabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003echolesterol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.71 (1.23 ; 11.22), p\u0026thinsp;=\u0026thinsp;0.020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent tobacco smoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecardiac disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.35 (0.15 ; 0.85), p\u0026thinsp;=\u0026thinsp;0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePuncture time to recan. (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNIHSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.88 (0.83 ; 0.93), p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study focused on the outcomes for patients undergoing acute TL treatment under triple APT and analysis of the stent patency and outcome 24 h and 90 days after the procedure.\u003c/p\u003e \u003cp\u003eExtracranial stent patency at 24 h correlates with a better clinical outcome, and intravenous thrombolytic therapy accompanying thrombectomy was found to have a positive influence on stent patency. Recent studies advocate an aggressive APT in the initial phase to keep the stent open(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe reported rates of restenosis or non-patency of the ICA after TL treatment at 24 h was reported to be 20.9%(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) in a recent large-volume multicenter analysis covering 225 patients; 22%(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) in a recent single-center analysis covering 99 patients with TL treatment through CAS; 55.4% in a single-center retrospective study covering 83 comparable patients(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e); and 56.9% in an analysis of two multicenter international observational registries covering 65 patients with comparable TL treatment(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAmong the patients included in this study, 33% (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;58) received intravenous thrombolysis. However, stent patency at 24 h was 100% in our study, and there was no significant influence of thrombolysis on the patency of the stent for the extracranial carotid artery (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e; Appendix).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of preceding major case studies. Abbreviations: Cyclooxygenase Inhibitor - COXI; Glycoprotein IIb/IIIa inhibitor - GP-IIb/IIIa-I; P2Y12-antagnosit P2Y12. * Authors do not differentiate symptomatic and any intracerebral hematoma.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuthor (year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eICA re-occlusion at 24h\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003esICH\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003emRS 0\u0026ndash;2 at 90d\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAPT\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAllard et al. (2023)(14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003en.a.*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e54.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCOXI and P2Y12 or GP-IIb/IIIa-I\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRen\u0026uacute; et al. (2020)(15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e66.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCOXI and P2Y12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBricout et al. (2018)(6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCOXI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarnat et al. (2020)(3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e54%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003en.a.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eData in this study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCOXI and P2Y12 and GP-IIb/IIIa-I\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe rate of extracranial ICA restenosis after 90 days in this study was 4.5% (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8). In this small case number, no influencing factor of significance could be identified. The number of patients with a mRS score of 0\u0026ndash;2 at day 90 was within the range of published data, albeit in the lower section. The comparably low rate may be caused by the fact that patients included in this study had a long time from onset/last seen well to puncture (mean 302 minutes, range 66-3014 minutes).\u003c/p\u003e \u003cp\u003eDespite the fact that patients in our study had the most aggressive APT, the rate of sICH was the lowest within the mentioned studies (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). In contrast to a hyperperfusion syndrome as the cause for sICH, requiring patency of the formerly occluded or stenotic ipsilateral ICA, sICH following TL treatment may be more frequent in patients with stent-/ICA-reocclusion\u003csup\u003e5\u003c/sup\u003e. Furthermore, the development of sICH is highly dependent on the postinterventional management of systolic blood pressure, which may be underreported in previous studies.\u003c/p\u003e \u003cp\u003eHowever, data on factors influencing the development of sICH following TL treatment are too few, and also, in this study, no factor of significant influence could be identified. Still, in concordance with previously published data, the mortality of patients suffering from sICH is high at 50% in this study.\u003c/p\u003e \u003cp\u003eFurthermore, in accordance with previous reports(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), the correlation between NIHSS and a 90-day mRS score of 3\u0026ndash;6 was found to be significant in our data.\u003c/p\u003e \u003cp\u003eA direct proportionality between time of intervention, number of recanalization attempts, and futile recanalization attempts on a negative, unfavorable outcome is well described for thrombectomy(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). This however accounts for non-tandem, solitary lesions in the anterior circulation. Therefore, a question we wanted to investigate with our data was whether in the often-complex treatment of tandem lesions, supposedly originating from a chronic ICA stenosis, there is a point in intervention after which the chance of reversing stroke is overweighed by the risk of harming the patient, i.e., a time to stop.\u003c/p\u003e \u003cp\u003eHowever, regarding the 90-day mRS scores, there was no significant influence of the time from groin puncture to recanalization.\u003c/p\u003e \u003cp\u003eAt a mean time of 92 minutes from groin puncture to recanalization TICI2b, the mean interventional treatment time was longer than treating an intracranial vessel occlusion alone, and nearly twice as long as in a 2016 meta-analysis on thrombectomy covering 1287 patients(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). In this meta-analysis, a longer time to reperfusion was found to increase the risk of a worse outcome, congruent with other more recent studies on thrombectomy in purely intracranial vessel occlusion(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, even in the group of patients undergoing interventional treatment with puncture-to-recanalization times beyond 120 min in our study (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;44; 25%), only 3 patients/6.8% (1.7% in total) did not maintain or improve their discharge mRS at 90 days, but fell by one score point each.\u003c/p\u003e \u003cp\u003eThe rate of in-hospital death in this subgroup was higher with \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7/15.9% vs. \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;17/12.88% in the group of patients having endovascular procedures shorter than 120 min. However, all 7 patients with in-hospital death in the group with time-to-reperfusion beyond 120 min arrived at the hospital with a higher NIHSS (mean 14 [9\u0026ndash;24] vs. 13 [14\u0026ndash;27]) and had a longer time of onset to puncture (mean 366.7 min [196\u0026ndash;622 min] vs. mean 302.16 min [66\u0026ndash;871 min]). The latter two factors, known to have a negative effect on outcome, may be an explanation for the slightly higher in-hospital mortality rate in the group with the longer time from puncture to recanalization. Nevertheless, the cause of death was connected to the infarction in only 3 of the 7 patients in this study.\u003c/p\u003e \u003cp\u003eHowever, a lack of association between the timing of puncture and recanalization in TL could be explained by the fact that most TL patients probably had chronic moderate- to high-grade stenosis of the extracranial portion of the carotid artery that preceded the occlusion leading to clinical presentation. In such a setting, the brain may have already developed collateralization to cope with the chronically reduced blood flow, resulting in less severe cut of blood supply upon vessel occlusion.\u003c/p\u003e \u003cp\u003eThe number of patients with in-hospital death who had more than 3 attempts of intracranial thrombectomy is however high at 27.3% (6/22). 36.4%/\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8 patients did not show improved mRS scored at discharge in this subgroup of patients, while only 27.3%/6 patients improved. This finding is concordant with the results of a major stroke registry analysis describing the odds for a favorable outcome of mechanical thrombectomy as the highest for patients with a maximum of 3 intracranial retrieval attempts(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn TL treatment with triple APT, the rate of patent vessels in this data was higher than published data for dual or single APT at a comparable rate of favorable mRS at 90 days, but at a lower rate of sICH. Also, the restenosis rate after 90 days was low with triple APT. This suggests that an initially aggressive APT may be critical for stent patency and may not influence the rate of sICH. However, more data are needed to confirm this hypothesis.\u003c/p\u003e \u003cp\u003eIn addition, there is no relationship between the duration of the procedure and outcome in our data, suggesting that even if the procedure is laborious and difficult, revascularization should be pursued, as it can be a worthwhile endeavor.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAPT\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Anti-platelet therapy\u003c/p\u003e\n\u003cp\u003eASA\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Acetyl-salicylic acid\u003c/p\u003e\n\u003cp\u003eCAS\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Carotid artery stenting\u003c/p\u003e\n\u003cp\u003eDSA\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Digital subtraction angiography\u003c/p\u003e\n\u003cp\u003eICA\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Internal carotid artery\u003c/p\u003e\n\u003cp\u003emRS\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Modified ranking scale\u003c/p\u003e\n\u003cp\u003ePTA\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Percutaneous transluminal angioplasty\u003c/p\u003e\n\u003cp\u003esICH\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Symptomatic intracranial hematoma\u003c/p\u003e\n\u003cp\u003eTICI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Thrombolysis in cerebral infarction\u003c/p\u003e\n\u003cp\u003eTL \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Tandem lesion\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis single-center retrospective analysis was conducted in accordance with the Declaration of Helsinki and approved by the local ethics committee (\u0026Auml;rztekammer Nord-W\u0026uuml;rttemberg, Stuttgart, Germany IRB number: F-2012-077).\u003c/p\u003e\n\u003cp\u003eInformed consent to participate in the study and to the publication of the data was obtained from all subjects.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cem\u003eFunding and disclosure of potential conflict of interests/competing interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNo funds or grants were provided for this work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eH. Henkes: Consulting and proctoring for phenox GmbH, co-owner of CONTARA GmbH.\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no further potential conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cem\u003eConcerning the authors\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis work complies with all instructions to authors. Authorship requirements have been met and the final manuscript was approved for publication by all authors.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cem\u003eConcerning publishing\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis manuscript has not been published elsewhere and is not under consideration\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eby another journal. Data and results described in this manuscript have not been presented elsewhere.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cem\u003eAuthor\u0026rsquo;s contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA. Khanafer, H. Henkes and P. von Gottberg conceived the manuscript. A. Khanafer has collected the data. A. Khanafer, P. B\u0026uuml;cke, F. Hennersdorf and H. B\u0026auml;zner evaluated the data. A. Khanafer and P. von Gottberg wrote the manuscript. H. Henkes, M. Forsting and H. B\u0026auml;zner advised on reference selection. H. Henkes, M. Forsting and H. B\u0026auml;zner proofread the manuscript.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cem\u003eAvailability of data and materials\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article (and its supplementary information files).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHigashida RT, Furlan AJ. Trial Design and Reporting Standards for Intra-Arterial Cerebral Thrombolysis for Acute Ischemic Stroke. Stroke [Internet]. 2003 Aug [cited 2023 Aug 8];34(8). Available from: https://www.ahajournals.org/doi/10.1161/01.STR.0000082721.62796.09\u003c/li\u003e\n\u003cli\u003eZhu F, Bracard S, Anxionnat R, Derelle AL, Tonnelet R, Liao L, et al. Impact of Emergent Cervical Carotid Stenting in Tandem Occlusion Strokes Treated by Thrombectomy: A Review of the TITAN Collaboration. Front Neurol. 2019 Mar 11;10:206. \u003c/li\u003e\n\u003cli\u003eMarnat G, Lapergue B, Sibon I, Gariel F, Bourcier R, Kyheng M, et al. Safety and Outcome of Carotid Dissection Stenting During the Treatment of Tandem Occlusions: A Pooled Analysis of TITAN and ETIS. Stroke. 2020 Dec;51(12):3713\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003ePop R, Zinchenko I, Quenardelle V, Mihoc D, Manisor M, Richter JS, et al. Predictors and Clinical Impact of Delayed Stent Thrombosis after Thrombectomy for Acute Stroke with Tandem Lesions. Am J Neuroradiol. 2019 Feb 14;ajnr;ajnr.A5976v1. \u003c/li\u003e\n\u003cli\u003eAnadani M, Spiotta AM, Alawieh A, Turjman F, Piotin M, Haussen DC, et al. Emergent Carotid Stenting Plus Thrombectomy After Thrombolysis in Tandem Strokes: Analysis of the TITAN Registry. Stroke. 2019 Aug;50(8):2250\u0026ndash;2. \u003c/li\u003e\n\u003cli\u003eBricout N, Personnic T, Ferrigno M, Labreuche J, Estrade L, Bretzner M, et al. Day 1 Extracranial Internal Carotid Artery Patency Is Associated With Good Outcome After Mechanical Thrombectomy for Tandem Occlusion. Stroke. 2018 Oct;49(10):2520\u0026ndash;2. \u003c/li\u003e\n\u003cli\u003eRana A, Yu S, Reid-Herrera S, Kamen S, Hunter K, Shaikh H, et al. Eptifibatide use in ischemic stroke patients undergoing endovascular thrombectomy: A matched cohort analysis. Front Neurol. 2022 Sep 27;13:939215. \u003c/li\u003e\n\u003cli\u003eJost A, Roels C, Brown M, Janjua R, Heck D. Low-Dose Eptifibatide for Tandem Occlusion in Stroke: Safety and Carotid Artery Patency. Am J Neuroradiol. 2021 Apr;42(4):738\u0026ndash;42. \u003c/li\u003e\n\u003cli\u003eOsteraas ND, Crowley RW, Panos N, Dafer RM. Eptifibatide use following emergent carotid stenting in acute anterior circulation ischemic stroke with tandem occlusion. J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105021. \u003c/li\u003e\n\u003cli\u003eDiana F, Abdalkader M, Behme D, Li W, Maurer CJ, Pop R, et al. Antithrombotic regimen in emergent carotid stenting for acute ischemic stroke due to tandem occlusion: a meta-analysis of aggregate data. J NeuroInterventional Surg. 2023 Apr 25;jnis-2023-020204. \u003c/li\u003e\n\u003cli\u003eBeneficial Effect of Carotid Endarterectomy in Symptomatic Patients with High-Grade Carotid Stenosis. N Engl J Med. 1991 Aug 15;325(7):445\u0026ndash;53. \u003c/li\u003e\n\u003cli\u003ePark JS, Lee JM, Kwak HS, Chung GH. Endovascular treatment of acute carotid atherosclerotic tandem occlusions: Predictors of clinical outcomes as technical aspects and location of tandem occlusions. J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105090. \u003c/li\u003e\n\u003cli\u003ePu M, Chen J, Chen Z, Li Z, Li Z, Tang Y, et al. Predictors and outcome of malignant cerebral edema after successful reperfusion in anterior circulation stroke. J Stroke Cerebrovasc Dis. 2023 Jun;32(6):107139. \u003c/li\u003e\n\u003cli\u003eAllard J, Delvoye F, Pop R, Labreuche J, Maier B, Marnat G, et al. 24-Hour Carotid Stent Patency and Outcomes After Endovascular Therapy: A Multicenter Study. Stroke. 2023 Jan;54(1):124\u0026ndash;31. \u003c/li\u003e\n\u003cli\u003eRen\u0026uacute; A, Blasco J, Laredo C, Llull L, Urra X, Obach V, et al. Carotid stent occlusion after emergent stenting in acute ischemic stroke: Incidence, predictors and clinical relevance. Atherosclerosis. 2020 Nov;313:8\u0026ndash;13. \u003c/li\u003e\n\u003cli\u003eFlottmann F, Brekenfeld C, Broocks G, Leischner H, McDonough R, Faizy TD, et al. Good Clinical Outcome Decreases With Number of Retrieval Attempts in Stroke Thrombectomy: Beyond the First-Pass Effect. Stroke. 2021 Feb;52(2):482\u0026ndash;90. \u003c/li\u003e\n\u003cli\u003eSaver JL, Goyal M, Van Der Lugt A, Menon BK, Majoie CBLM, Dippel DW, et al. Time to Treatment With Endovascular Thrombectomy and Outcomes From Ischemic Stroke: A Meta-analysis. JAMA. 2016 Sep 27;316(12):1279. \u003c/li\u003e\n\u003cli\u003eCappellari M, Saia V, Pracucci G, Fainardi E, Casetta I, Sallustio F, et al. Predictors for clinical and functional outcomes in stroke patients with first‐pass complete recanalization after thrombectomy. Eur J Neurol. 2023 May 9;ene.15842. \u003c/li\u003e\n\u003cli\u003eDesai S, Aghaebrahim AN, Siegler JE, Monteiro A, Jadhav AP, Jovin TG. Abstract P481: Time to Reperfusion Determines Clinical Outcomes Independent of Post Thrombectomy Infarct Volume. Stroke [Internet]. 2021 Mar [cited 2023 May 19];52(Suppl_1). Available from: https://www.ahajournals.org/doi/10.1161/str.52.suppl_1.P481\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-neurology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurl","sideBox":"Learn more about [BMC Neurology](http://bmcneurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurl","title":"BMC Neurology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Stroke, Carotid artery stenting, Endovascular thrombectomy, In-Stent restenosis, anti-platelet therapy","lastPublishedDoi":"10.21203/rs.3.rs-3848031/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3848031/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAcute stroke treatment with intracranial thrombectomy and treatment of ipsilateral carotid artery stenosis/occlusion (\u0026ldquo;tandem lesion\u0026rdquo;, TL) in one session is considered safe. However, the risk of stent restenosis after TL treatment is high, and antiplatelet therapy (APT) preventing restenosis must be well balanced to avoid intracranial hemorrhage. We investigated the safety and 90-day outcome of patients receiving TL treatment under triple-APT, focused on stent-patency and possible disadvantageous comorbidities.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003ePatients receiving TL treatment in the setting of acute stroke between 2013 and 2022 were analyzed regarding peri-/postprocedural safety and stent patency after 90 days. All patients received intravenous eptifibatide and acetylsalicylic acid and one of the three drugs prasugrel, clopidogrel, or ticagrelor. Duplex imaging was performed 24h after treatment, at discharge and 90 days, and digital subtraction angiography was performed if restenosis was suspected.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e176 patients were included. Periprocedural complications occurred in 2.3% of the patients at no periprocedural death, and in-hospital death in 13.6%. Discharge mRS score was maintained or improved at the 90-day follow-up in 86%, 4.54% had an in-stent restenosis requiring treatment at 90 days. No recorded comorbidity considered disadvantageous for stent patency showed statistical significance, the duration of the endovascular procedure had no significant effect on outcome.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eTL treatment with triple APT resulted in a lower restenosis rate, comparable rates of sICH and mRS in comparison to single and dual APT. Aggressive APT in the initial phase may therefore prevent recurrent stroke better than restrained platelet inhibition. Comorbidities did not influence stent patency.\u003c/p\u003e","manuscriptTitle":"Triple Platelet Inhibition in Intracranial Thrombectomy with Additional Acute Cervical Stent Angioplasty due to Tandem Lesion: A retrospective single-center analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-17 07:16:06","doi":"10.21203/rs.3.rs-3848031/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-02-02T15:21:49+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-02-01T22:02:52+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-01-22T17:40:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"c6506e09-41cf-44ff-830c-912c28bd5bca","date":"2024-01-22T05:08:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"5ef0e12b-c9f9-4277-bbd7-df83c784ddbc","date":"2024-01-21T21:33:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-01-21T21:26:40+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-01-16T19:41:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-01-15T14:47:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-01-15T14:47:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Neurology","date":"2024-01-09T11:07:13+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-neurology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurl","sideBox":"Learn more about [BMC Neurology](http://bmcneurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurl","title":"BMC Neurology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"40ea6bed-8799-4c68-9068-e968df47bf3a","owner":[],"postedDate":"January 17th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-03-25T15:11:55+00:00","versionOfRecord":{"articleIdentity":"rs-3848031","link":"https://doi.org/10.1186/s12883-024-03597-0","journal":{"identity":"bmc-neurology","isVorOnly":false,"title":"BMC Neurology"},"publishedOn":"2024-03-18 15:02:55","publishedOnDateReadable":"March 18th, 2024"},"versionCreatedAt":"2024-01-17 07:16:06","video":"","vorDoi":"10.1186/s12883-024-03597-0","vorDoiUrl":"https://doi.org/10.1186/s12883-024-03597-0","workflowStages":[]},"version":"v1","identity":"rs-3848031","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3848031","identity":"rs-3848031","version":["v1"]},"buildId":"cTy_lsJlmDsVRNrSptgXS","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}