Endovascular Thrombectomy Versus Intravenous Thrombolysis in Acute Ischemic Stroke With Tandem Occlusion: A Stratified Comparative Outcome Analysis Across NIHSS Severity Strata
Keywords:
acute ischemic stroke, tandem occlusion, endovascular thrombectomy, intravenous thrombolysis, modified Rankin Scale, NIHSS severity stratification, reperfusion therapy, symptomatic intracranial hemorrhage, propensity-score matchingAbstract
Background: Tandem occlusion in acute ischemic stroke (AIS) presents a dual-vessel challenge demanding optimized reperfusion strategies. Controversy persists regarding the superiority of endovascular thrombectomy (EVT) over intravenous thrombolysis (IVT) across varying National Institutes of Health Stroke Scale (NIHSS) severity strata. Methods: A multicenter retrospective cohort of 614 AIS patients with confirmed tandem occlusion was analyzed. Propensity-score matching balanced baseline characteristics. Primary endpoints included 90-day modified Rankin Scale (mRS) scores, recanalization rates (TICI ≥2b), and symptomatic intracranial hemorrhage (sICH) incidence. Results: EVT demonstrated significantly superior functional independence (mRS 0–2: 58.3% vs. 34.7%, p<0.001) and recanalization (81.6% vs. 49.2%, p<0.001). sICH rates were comparable. Benefit was most pronounced in NIHSS ≥15 subgroups. Conclusions: EVT constitutes the preferred reperfusion modality in tandem occlusion AIS, particularly in high-severity presentations, warranting protocol-level implementation in comprehensive stroke centers.
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