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<meta name="DC.Title" content="Carotid Stenting and Mechanical Thrombectomy in Patients with Acute Ischemic Stroke and Tandem Occlusions: Antithrombotic Treatment and Functional Outcome" />
<meta name="DC.Identifier" content="10.3174/ajnr.A6768" />
<meta name="DC.Date" content="2020-11-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2020 by American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: There is no consensus on the optimal antithrombotic medication for patients with acute ischemic stroke with anterior circulation tandem occlusions treated with emergent carotid stent placement and mechanical thrombectomy. The identification of factors influencing hemorrhagic risks can assist in creating appropriate therapeutic algorithms for such patients. This study aimed to investigate the impact of medical therapy on functional and safety outcomes in patients treated with carotid stent placement and mechanical thrombectomy for tandem occlusions.

MATERIALS AND METHODS: A multicenter retrospective study on prospectively collected data was conducted. Only patients treated with carotid stent placement and mechanical thrombectomy for tandem occlusions of the anterior circulation were included. Univariate and multivariate analyses were performed on preprocedural, procedural, and postprocedural variables to assess factors influencing clinical outcome, symptomatic intracranial hemorrhage, stent patency, and successful intracranial vessel recanalization.

RESULTS: Ninety-five patients with acute ischemic stroke and tandem occlusions were included. Good clinical outcome (mRS ≤ 2) at 3 months was reached by 33 (39.3%) patients and was associated with baseline ASPECTS ≥ 8 (OR = 1.53; 95% CI, 1.16–2.00), ≤2 mechanical thrombectomy attempts (OR = 0.71; 95% CI, 0.55–0.99), and the absence of symptomatic intracranial hemorrhage (OR = 0.13; 95% CI , 0.03–0.51). Symptomatic intracranial hemorrhage was associated with a higher amount of intraprocedural heparin, ASPECTS ≤ 7, and ≥3 mechanical thrombectomy attempts. No relationships among types of acute antiplatelet regimen, intravenous thrombolysis, and symptomatic intracranial hemorrhage were observed. Patients receiving dual-antiplatelet therapy after hemorrhagic transformation had been ruled out on 24-hour CT were more likely to achieve functional independence and had a lower risk of symptomatic intracranial hemorrhage.

CONCLUSIONS: During carotid stent placement and mechanical thrombectomy for tandem occlusion treatment, higher intraprocedural heparin dosage (≥3000 IU) increased symptomatic intracranial hemorrhage risk when the initial ASPECTS was ≤7, and mechanical thrombectomy needs more than one passage for complete recanalization. Antiplatelets antiplatelets use were safe, and dual-antiaggregation therapy was related to better functional outcomes.

AIS
:   acute ischemic stroke
ICH
:   intracranial hemorrhage
MT
:   mechanical thrombectomy
sICH
:   symptomatic intracranial hemorrhage
TO
:   tandem occlusion" />
<meta name="DC.Contributor" content="V. Da Ros" />
<meta name="DC.Contributor" content="J. Scaggiante" />
<meta name="DC.Contributor" content="F. Sallustio" />
<meta name="DC.Contributor" content="S. Lattanzi" />
<meta name="DC.Contributor" content="M. Bandettini" />
<meta name="DC.Contributor" content="A. Sgreccia" />
<meta name="DC.Contributor" content="C. Rolla-Bigliani" />
<meta name="DC.Contributor" content="E. Lafe" />
<meta name="DC.Contributor" content="G. Sanfilippo" />
<meta name="DC.Contributor" content="M. Diomedi" />
<meta name="DC.Contributor" content="M. Ruggiero" />
<meta name="DC.Contributor" content="N. Haznedari" />
<meta name="DC.Contributor" content="M. Giannoni" />
<meta name="DC.Contributor" content="C. Finocchi" />
<meta name="DC.Contributor" content="R. Floris" />
<meta name="article:published_time" content="2020-11-01" />
<meta name="article:section" content="Interventional" />
<meta name="citation_title" content="Carotid Stenting and Mechanical Thrombectomy in Patients with Acute Ischemic Stroke and Tandem Occlusions: Antithrombotic Treatment and Functional Outcome" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;There is no consensus on the optimal antithrombotic medication for patients with acute ischemic stroke with anterior circulation tandem occlusions treated with emergent carotid stent placement and mechanical thrombectomy. The identification of factors influencing hemorrhagic risks can assist in creating appropriate therapeutic algorithms for such patients. This study aimed to investigate the impact of medical therapy on functional and safety outcomes in patients treated with carotid stent placement and mechanical thrombectomy for tandem occlusions.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;A multicenter retrospective study on prospectively collected data was conducted. Only patients treated with carotid stent placement and mechanical thrombectomy for tandem occlusions of the anterior circulation were included. Univariate and multivariate analyses were performed on preprocedural, procedural, and postprocedural variables to assess factors influencing clinical outcome, symptomatic intracranial hemorrhage, stent patency, and successful intracranial vessel recanalization.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Ninety-five patients with acute ischemic stroke and tandem occlusions were included. Good clinical outcome (mRS ≤ 2) at 3 months was reached by 33 (39.3%) patients and was associated with baseline ASPECTS ≥ 8 (OR = 1.53; 95% CI, 1.16–2.00), ≤2 mechanical thrombectomy attempts (OR = 0.71; 95% CI, 0.55–0.99), and the absence of symptomatic intracranial hemorrhage (OR = 0.13; 95% CI , 0.03–0.51). Symptomatic intracranial hemorrhage was associated with a higher amount of intraprocedural heparin, ASPECTS ≤ 7, and ≥3 mechanical thrombectomy attempts. No relationships among types of acute antiplatelet regimen, intravenous thrombolysis, and symptomatic intracranial hemorrhage were observed. Patients receiving dual-antiplatelet therapy after hemorrhagic transformation had been ruled out on 24-hour CT were more likely to achieve functional independence and had a lower risk of symptomatic intracranial hemorrhage.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;During carotid stent placement and mechanical thrombectomy for tandem occlusion treatment, higher intraprocedural heparin dosage (≥3000 IU) increased symptomatic intracranial hemorrhage risk when the initial ASPECTS was ≤7, and mechanical thrombectomy needs more than one passage for complete recanalization. Antiplatelets antiplatelets use were safe, and dual-antiaggregation therapy was related to better functional outcomes.&lt;/p&gt;" />
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<meta name="citation_author" content="V. Da Ros" />
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<meta name="twitter:title" content="Carotid Stenting and Mechanical Thrombectomy in Patients with Acute Ischemic Stroke and Tandem Occlusions: Antithrombotic Treatment and Functional Outcome" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: There is no consensus on the optimal antithrombotic medication for patients with acute ischemic stroke with anterior circulation tandem occlusions treated with emergent carotid stent placement and mechanical thrombectomy. The identification of factors influencing hemorrhagic risks can assist in creating appropriate therapeutic algorithms for such patients. This study aimed to investigate the impact of medical therapy on functional and safety outcomes in patients treated with carotid stent placement and mechanical thrombectomy for tandem occlusions.

MATERIALS AND METHODS: A multicenter retrospective study on prospectively collected data was conducted. Only patients treated with carotid stent placement and mechanical thrombectomy for tandem occlusions of the anterior circulation were included. Univariate and multivariate analyses were performed on preprocedural, procedural, and postprocedural variables to assess factors influencing clinical outcome, symptomatic intracranial hemorrhage, stent patency, and successful intracranial vessel recanalization.

RESULTS: Ninety-five patients with acute ischemic stroke and tandem occlusions were included. Good clinical outcome (mRS ≤ 2) at 3 months was reached by 33 (39.3%) patients and was associated with baseline ASPECTS ≥ 8 (OR = 1.53; 95% CI, 1.16–2.00), ≤2 mechanical thrombectomy attempts (OR = 0.71; 95% CI, 0.55–0.99), and the absence of symptomatic intracranial hemorrhage (OR = 0.13; 95% CI , 0.03–0.51). Symptomatic intracranial hemorrhage was associated with a higher amount of intraprocedural heparin, ASPECTS ≤ 7, and ≥3 mechanical thrombectomy attempts. No relationships among types of acute antiplatelet regimen, intravenous thrombolysis, and symptomatic intracranial hemorrhage were observed. Patients receiving dual-antiplatelet therapy after hemorrhagic transformation had been ruled out on 24-hour CT were more likely to achieve functional independence and had a lower risk of symptomatic intracranial hemorrhage.

CONCLUSIONS: During carotid stent placement and mechanical thrombectomy for tandem occlusion treatment, higher intraprocedural heparin dosage (≥3000 IU) increased symptomatic intracranial hemorrhage risk when the initial ASPECTS was ≤7, and mechanical thrombectomy needs more than one passage for complete recanalization. Antiplatelets antiplatelets use were safe, and dual-antiaggregation therapy was related to better functional outcomes.

AIS
:   acute ischemic stroke
ICH
:   intracranial hemorrhage
MT
:   mechanical thrombectomy
sICH
:   symptomatic intracranial hemorrhage
TO
:   tandem occlusion" />
<meta name="og-title" property="og:title" content="Carotid Stenting and Mechanical Thrombectomy in Patients with Acute Ischemic Stroke and Tandem Occlusions: Antithrombotic Treatment and Functional Outcome" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/41/11/2088" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: There is no consensus on the optimal antithrombotic medication for patients with acute ischemic stroke with anterior circulation tandem occlusions treated with emergent carotid stent placement and mechanical thrombectomy. The identification of factors influencing hemorrhagic risks can assist in creating appropriate therapeutic algorithms for such patients. This study aimed to investigate the impact of medical therapy on functional and safety outcomes in patients treated with carotid stent placement and mechanical thrombectomy for tandem occlusions.

MATERIALS AND METHODS: A multicenter retrospective study on prospectively collected data was conducted. Only patients treated with carotid stent placement and mechanical thrombectomy for tandem occlusions of the anterior circulation were included. Univariate and multivariate analyses were performed on preprocedural, procedural, and postprocedural variables to assess factors influencing clinical outcome, symptomatic intracranial hemorrhage, stent patency, and successful intracranial vessel recanalization.

RESULTS: Ninety-five patients with acute ischemic stroke and tandem occlusions were included. Good clinical outcome (mRS ≤ 2) at 3 months was reached by 33 (39.3%) patients and was associated with baseline ASPECTS ≥ 8 (OR = 1.53; 95% CI, 1.16–2.00), ≤2 mechanical thrombectomy attempts (OR = 0.71; 95% CI, 0.55–0.99), and the absence of symptomatic intracranial hemorrhage (OR = 0.13; 95% CI , 0.03–0.51). Symptomatic intracranial hemorrhage was associated with a higher amount of intraprocedural heparin, ASPECTS ≤ 7, and ≥3 mechanical thrombectomy attempts. No relationships among types of acute antiplatelet regimen, intravenous thrombolysis, and symptomatic intracranial hemorrhage were observed. Patients receiving dual-antiplatelet therapy after hemorrhagic transformation had been ruled out on 24-hour CT were more likely to achieve functional independence and had a lower risk of symptomatic intracranial hemorrhage.

CONCLUSIONS: During carotid stent placement and mechanical thrombectomy for tandem occlusion treatment, higher intraprocedural heparin dosage (≥3000 IU) increased symptomatic intracranial hemorrhage risk when the initial ASPECTS was ≤7, and mechanical thrombectomy needs more than one passage for complete recanalization. Antiplatelets antiplatelets use were safe, and dual-antiaggregation therapy was related to better functional outcomes.

AIS
:   acute ischemic stroke
ICH
:   intracranial hemorrhage
MT
:   mechanical thrombectomy
sICH
:   symptomatic intracranial hemorrhage
TO
:   tandem occlusion" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node80897--7" data-node-nid="80897" id="top-node-80897--82008409965" data-pisa="ajnr;41/11/2088" data-pisa-master="ajnr;ajnr.A6768" data-apath="/ajnr/41/11/2088.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">Interventional</span></span></div>
  
      <div class="highwire-cite-access"><span class="highwire-citation-access highwire-citation-access-check" data-pisa-id="ajnr;ajnr.A6768" data-atom-uri="/ajnr/41/11/2088.atom" data-request-view="full"></span></div>
  
      <h1 class="highwire-cite-title" id="page-title">Carotid Stenting and Mechanical Thrombectomy in Patients with Acute Ischemic Stroke and Tandem Occlusions: Antithrombotic Treatment and Functional Outcome</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">V. Da Ros</span>, <span class="highwire-citation-author" data-delta="1">J. Scaggiante</span>, <span class="highwire-citation-author" data-delta="2">F. Sallustio</span>, <span class="highwire-citation-author" data-delta="3">S. Lattanzi</span>, <span class="highwire-citation-author" data-delta="4">M. Bandettini</span>, <span class="highwire-citation-author" data-delta="5">A. Sgreccia</span>, <span class="highwire-citation-author" data-delta="6">C. Rolla-Bigliani</span>, <span class="highwire-citation-author" data-delta="7">E. Lafe</span>, <span class="highwire-citation-author" data-delta="8">G. Sanfilippo</span>, <span class="highwire-citation-author" data-delta="9">M. Diomedi</span>, <span class="highwire-citation-author" data-delta="10">M. Ruggiero</span>, <span class="highwire-citation-author" data-delta="11">N. Haznedari</span>, <span class="highwire-citation-author" data-delta="12">M. Giannoni</span>, <span class="highwire-citation-author" data-delta="13">C. Finocchi</span> and <span class="highwire-citation-author" data-delta="14">R. Floris</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">November 2020,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">41 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(11) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">2088-2093; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A6768 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-80897--82008409965" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">V. Da Ros </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Biomedicine and Prevention (V.D.R., J.S., R.F.), Interventional Neuroradiology Unit</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=V.%2BDa%2BRos%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Da%20Ros%20V&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AV.%2BDa%2BRos%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-7167-7594" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for V. Da Ros</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">J. Scaggiante </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Biomedicine and Prevention (V.D.R., J.S., R.F.), Interventional Neuroradiology Unit</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BScaggiante%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Scaggiante%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.%2BScaggiante%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-9531-9131" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. Scaggiante</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">F. Sallustio </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Comprehensive Stroke Center (F.S., M.D.), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=F.%2BSallustio%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Sallustio%20F&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AF.%2BSallustio%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-8229-465X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for F. Sallustio</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">S. Lattanzi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BLattanzi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Lattanzi%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AS.%2BLattanzi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-8748-0083" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S. Lattanzi</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">M. Bandettini </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Neurological Clinic (M.B., C.F.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BBandettini%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Bandettini%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.%2BBandettini%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-8871-1103" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. Bandettini</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">A. Sgreccia </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>e</span>Department of Neurosciences and Interventional Neuroradiology Unit (A.S., E.L., G.S.), IRCCS Policlinico San Matteo, Pavia, Italy</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.%2BSgreccia%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Sgreccia%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AA.%2BSgreccia%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-0834-644X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A. Sgreccia</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">C. Rolla-Bigliani </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>f</span>Department of Diagnostic and Interventional Neuroradiology (C.R.-B.), Policlinico Universitario, San Martino, Italy</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=C.%2BRolla-Bigliani%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Rolla-Bigliani%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AC.%2BRolla-Bigliani%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-8996-5498" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for C. Rolla-Bigliani</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">E. Lafe </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>e</span>Department of Neurosciences and Interventional Neuroradiology Unit (A.S., E.L., G.S.), IRCCS Policlinico San Matteo, Pavia, Italy</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=E.%2BLafe%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Lafe%20E&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AE.%2BLafe%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-0509-0044" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for E. Lafe</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name">G. Sanfilippo </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>e</span>Department of Neurosciences and Interventional Neuroradiology Unit (A.S., E.L., G.S.), IRCCS Policlinico San Matteo, Pavia, Italy</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=G.%2BSanfilippo%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Sanfilippo%20G&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AG.%2BSanfilippo%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-2598-3627" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for G. Sanfilippo</a></li></ul></div><div class="author-tooltip-9"><div class="author-tooltip-name">M. Diomedi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Comprehensive Stroke Center (F.S., M.D.), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BDiomedi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Diomedi%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.%2BDiomedi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-7569-1414" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. Diomedi</a></li></ul></div><div class="author-tooltip-10"><div class="author-tooltip-name">M. Ruggiero </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>g</span>Neuroradiology Unit (M.R., N.H.), AUSL Romagna, Cesena, Italy</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BRuggiero%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Ruggiero%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.%2BRuggiero%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-3612-4289" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. Ruggiero</a></li></ul></div><div class="author-tooltip-11"><div class="author-tooltip-name">N. Haznedari </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>g</span>Neuroradiology Unit (M.R., N.H.), AUSL Romagna, Cesena, Italy</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=N.%2BHaznedari%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Haznedari%20N&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AN.%2BHaznedari%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-7616-1471" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for N. Haznedari</a></li></ul></div><div class="author-tooltip-12"><div class="author-tooltip-name">M. Giannoni </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>h</span>Neuroradiological Clinic (M.G.), Department of Radiological Sciences, AOU Ospedali Riuniti, Ancona, Italy.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BGiannoni%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Giannoni%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.%2BGiannoni%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-2705-4266" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. Giannoni</a></li></ul></div><div class="author-tooltip-13"><div class="author-tooltip-name">C. Finocchi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Neurological Clinic (M.B., C.F.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=C.%2BFinocchi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Finocchi%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AC.%2BFinocchi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-4385-1203" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for C. Finocchi</a></li></ul></div><div class="author-tooltip-14"><div class="author-tooltip-name">R. Floris </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Biomedicine and Prevention (V.D.R., J.S., R.F.), Interventional Neuroradiology Unit</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=R.%2BFloris%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Floris%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AR.%2BFloris%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-6098-2232" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for R. Floris</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div xmlns:xhtml="http://www.w3.org/1999/xhtml" class="contributors"><ol class="contributor-list" id="contrib-group-1"><li class="contributor" id="contrib-1"><span class="name">V. Da Ros</span><a id="xref-aff-1-1" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-2"><span class="name">J. Scaggiante</span><a id="xref-aff-1-2" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-3"><span class="name">F. Sallustio</span><a id="xref-aff-2-1" class="xref-aff" href="#aff-2">b</a>, </li><li class="contributor" id="contrib-4"><span class="name">S. Lattanzi</span><a id="xref-aff-3-1" class="xref-aff" href="#aff-3">c</a>, </li><li class="contributor" id="contrib-5"><span class="name">M. Bandettini</span><a id="xref-aff-4-1" class="xref-aff" href="#aff-4">d</a>, </li><li class="contributor" id="contrib-6"><span class="name">A. Sgreccia</span><a id="xref-aff-5-1" class="xref-aff" href="#aff-5">e</a>, </li><li class="contributor" id="contrib-7"><span class="name">C. Rolla-Bigliani</span><a id="xref-aff-6-1" class="xref-aff" href="#aff-6">f</a>, </li><li class="contributor" id="contrib-8"><span class="name">E. Lafe</span><a id="xref-aff-5-2" class="xref-aff" href="#aff-5">e</a>, </li><li class="contributor" id="contrib-9"><span class="name">G. Sanfilippo</span><a id="xref-aff-5-3" class="xref-aff" href="#aff-5">e</a>, </li><li class="contributor" id="contrib-10"><span class="name">M. Diomedi</span><a id="xref-aff-2-2" class="xref-aff" href="#aff-2">b</a>, </li><li class="contributor" id="contrib-11"><span class="name">M. Ruggiero</span><a id="xref-aff-7-1" class="xref-aff" href="#aff-7">g</a>, </li><li class="contributor" id="contrib-12"><span class="name">N. Haznedari</span><a id="xref-aff-7-2" class="xref-aff" href="#aff-7">g</a>, </li><li class="contributor" id="contrib-13"><span class="name">M. Giannoni</span><a id="xref-aff-8-1" class="xref-aff" href="#aff-8">h</a>, </li><li class="contributor" id="contrib-14"><span class="name">C. Finocchi</span><a id="xref-aff-4-2" class="xref-aff" href="#aff-4">d</a> and </li><li class="last" id="contrib-15"><span class="name">R. Floris</span><a id="xref-aff-1-3" class="xref-aff" href="#aff-1">a</a></li></ol><ol class="affiliation-list"><li class="aff"><a id="aff-1" name="aff-1"></a><address><sup>a</sup>From the Department of Biomedicine and Prevention (V.D.R., J.S., R.F.), Interventional Neuroradiology Unit</address></li><li class="aff"><a id="aff-2" name="aff-2"></a><address><sup>b</sup>Comprehensive Stroke Center (F.S., M.D.), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy</address></li><li class="aff"><a id="aff-3" name="aff-3"></a><address><sup>c</sup>Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy</address></li><li class="aff"><a id="aff-4" name="aff-4"></a><address><sup>d</sup>Neurological Clinic (M.B., C.F.)</address></li><li class="aff"><a id="aff-5" name="aff-5"></a><address><sup>e</sup>Department of Neurosciences and Interventional Neuroradiology Unit (A.S., E.L., G.S.), IRCCS Policlinico San Matteo, Pavia, Italy</address></li><li class="aff"><a id="aff-6" name="aff-6"></a><address><sup>f</sup>Department of Diagnostic and Interventional Neuroradiology (C.R.-B.), Policlinico Universitario, San Martino, Italy</address></li><li class="aff"><a id="aff-7" name="aff-7"></a><address><sup>g</sup>Neuroradiology Unit (M.R., N.H.), AUSL Romagna, Cesena, Italy</address></li><li class="aff"><a id="aff-8" name="aff-8"></a><address><sup>h</sup>Neuroradiological Clinic (M.G.), Department of Radiological Sciences, AOU Ospedali Riuniti, Ancona, Italy.</address></li></ol><ol class="corresp-list"><li class="corresp" id="corresp-1">Please address correspondence to Valerio Da Ros, MD, <span class="addr-line">Department of Biomedicine, Interventional Neuroradiology unit, University of Rome Tor Vergata, Viale Oxford 81, Rome, Italy</span>; e-mail: <span class="em-link"><span class="em-addr">darosvalerio{at}gmail.com</span></span></li></ol></div></div><a href="http://ajnr-stage2.stage.highwire.org/content/41/11/2088.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">V.</span> <span class="nlm-surname">Da Ros</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Scaggiante</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">F.</span> <span class="nlm-surname">Sallustio</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Lattanzi</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Bandettini</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Sgreccia</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Rolla-Bigliani</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">E.</span> <span class="nlm-surname">Lafe</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Sanfilippo</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Diomedi</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Ruggiero</span></span>, <span class="highwire-citation-author" data-delta="11"><span class="nlm-given-names">N.</span> <span class="nlm-surname">Haznedari</span></span>, <span class="highwire-citation-author" data-delta="12"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Giannoni</span></span>, <span class="highwire-citation-author" data-delta="13"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Finocchi</span></span>, <span class="highwire-citation-author" data-delta="14"><span class="nlm-given-names">R.</span> <span class="nlm-surname">Floris</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Nov 2020, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">41 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(11) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">2088-2093; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A6768 </span></div>
  
  
  
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      <div class="highwire-cite-title">Carotid Stenting and Mechanical Thrombectomy in Patients with Acute Ischemic Stroke and Tandem Occlusions: Antithrombotic Treatment and Functional Outcome</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">V.</span> <span class="nlm-surname">Da Ros</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Scaggiante</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">F.</span> <span class="nlm-surname">Sallustio</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">S.</span> <span class="nlm-surname">Lattanzi</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Bandettini</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Sgreccia</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Rolla-Bigliani</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">E.</span> <span class="nlm-surname">Lafe</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Sanfilippo</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Diomedi</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Ruggiero</span></span>, <span class="highwire-citation-author" data-delta="11"><span class="nlm-given-names">N.</span> <span class="nlm-surname">Haznedari</span></span>, <span class="highwire-citation-author" data-delta="12"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Giannoni</span></span>, <span class="highwire-citation-author" data-delta="13"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Finocchi</span></span>, <span class="highwire-citation-author" data-delta="14"><span class="nlm-given-names">R.</span> <span class="nlm-surname">Floris</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Nov 2020, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">41 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(11) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">2088-2093; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A6768 </span></div>
  
  
  
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