Proximal Internal Carotid artery Acute Stroke Secondary to tandem Occlusions (PICASSO) international survey

Cynthia B. Zevallos, Mudassir Farooqui, Darko Quispe-Orozco, Alan Mendez-Ruiz, Mary Patterson, Kristine Below, Sheila O. Martins, Ossama Y. Mansour, Francisco Mont'alverne, Thanh N. Nguyen, Luis Lemme, Adnan H. Siddiqui, Justin F. Fraser, Ashutosh P. Jadhav, Osama O. Zaidat, Santiago Ortega-Gutierrez

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Background While mechanical thrombectomy (MT) is the standard of care for large vessel occlusion strokes, the optimal management of tandem occlusions (TO) remains uncertain. We aimed to determine the current practice patterns among stroke physicians involved in the treatment of TO during MT. Methods We distributed an online survey to neurovascular practitioners (stroke neurologists, neurointerventionalists, neurosurgeons, and radiologists), members of professional societies. After 2 months the site was closed and data were extracted and analyzed. We divided respondents into acute stenting and delayed treatment groups and responses were compared between the two groups. Results We received 220 responses from North America (48%), Latin America (28%), Asia (15%), Europe (5%), and Africa (4%). Preferred timing for cervical revascularization varied among respondents; 51% preferred treatment in a subsequent procedure during the same hospitalization whereas 39% preferred to treat during MT. Angioplasty and stenting (41%) was the preferred technique, followed by balloon angioplasty and local aspiration (38%). The risk of intracerebral hemorrhage was the most compelling reason for not stenting acutely (68%). There were no significant differences among practice characteristics and timing groups. Most practitioners (70%) agreed that there is equipoise regarding the optimal endovascular treatment of cervical lesions in TO; hence, 77% would participate in a randomized controlled trial. Conclusions The PICASSO survey demonstrates multiple areas of uncertainty regarding the medical and endovascular management of TOs. Experts acknowledged the need for further evidence and their willingness to participate in a randomized controlled trial to evaluate the best treatment for the cervical TO lesion.

Original languageEnglish
Pages (from-to)1106-1110
Number of pages5
JournalJournal of NeuroInterventional Surgery
Issue number12
StatePublished - Dec 1 2021

Bibliographical note

Publisher Copyright:
© IGCS and ESGO 2020.


  • Stenosis
  • intervention
  • standards
  • stent
  • stroke

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


Dive into the research topics of 'Proximal Internal Carotid artery Acute Stroke Secondary to tandem Occlusions (PICASSO) international survey'. Together they form a unique fingerprint.

Cite this