To explore the factors affecting the prognosis of endovascular treatment for anterior circulation tandem lesions.

The retrospective analysis collected the clinical data of 43 patients with acute anterior circulation tandem lesions admitted to Department of Neurology, Jianghan University Affiliated Third People's Hospital of Hubei Province from January 1, 2014 to December 31, 2019. According to the 90-day modified Rankin scale (mRS) after the operation, patients with mRS score 0-2 were defined as the good prognosis group, and patients with 3-6 as the poor prognosis group. For continuous variables such as age, National Institutes of Health Stroke Scale (NIHSS), and baseline Alberta stroke program early CT score (ASPECTS score), t test was used. Chi-square analysis was used for categorical variables such as gender, hypertension, diabetes, hyperlipidemia, coronary heart disease, smoking, atrial fibrillation, intravenous thrombolysis, carotid stent placement, thrombectomy times, vascular recanalization, symptomatic intracranial hemorrhage. Multivariate Logistic analysis was used to evaluate the factors affecting the prognosis of endovascular treatment for anterior circulation tandem lesions.

Compared with the poor prognosis group, the good prognosis group had a lower incidence of diabetes and coronary heart disease(2/23 vs 7/20, χ²=4.473, P=0.034; 3/23 vs 10/20, χ²=6.927, P=0.008), a higher baseline ASPECTS score [(7.61±2.06) vs (5.80±2.57), t=2.562, P=0.014], and fewer thrombus removals (22/23 vs 10/20; χ²=11.711, P＜0.001). Multivariate logistic regression analysis showed that no coronary heart disease (OR=0.049, P=0.007) and embolectomy ≤3 times (OR=0.470, P=0.026) were protective factors for prognosis, and baseline aspects score (OR=1.470, P=0.043) was another influence factor for prognosis (P＜0.05). The ASPECTS score threshold was 5 points, with the sensitivity of 91.3% and the specificity of 55.0%. The area under the ROC curve was 0.72 (P=0.014, 95% CI 0.564~0.876).

Patients with anterior circulation tandem lesions with an ASPECTS score ≥5 points, thrombectomy times ≤3 times, and no coronary heart disease are more likely to have a good prognosis.