We sequenced all genes of mitochondrial tRNAs of a patient with chronic progressive external ophthalmoplegia with 5% ragged red fibres and 15% COX-negative fibres but without macrorearrangements of ...mitochondrial DNA (mtDNA). Direct sequencing showed a novel heteroplasmic G
>
A substitution in position 12316 of tRNA
Leu(CUN) gene. This change destroys a highly conserved G–C base coupling in tRNA T
ψC branch. By RFLP analysis we could demonstrate different degrees of heteroplasmy in different patient's tissues. This alteration, absent in a population of 110 patients with different encephalomyopathies, can be considered pathogenic: it is the tenth tRNA
Leu(CUN) pathogenic mutation described up to date.
Purpose
The management of tandem extracranial internal carotid artery and intracranial large vessel occlusion during endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) has been ...under-investigated. We sought to investigate outcomes of AIS patients with tandem occlusion (TO) treated with carotid artery stenting (CAS) compared to those not treated with CAS (no-CAS) during EVT.
Methods
We performed a cohort study using data from AIS patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. Outcomes were 3 months’ mortality, functional outcome, complete and successful recanalization, any intracranial hemorrhage, parenchymal hematoma and symptomatic intracerebral hemorrhage.
Results
Among 466 AIS patients with TO, CAS patients were 122 and no-CAS patients were 226 (118 excluded). After adjustment for unbalanced variables, CAS was associated with a lower rate of 3 months’ mortality (OR 0.407, 95% CI 0.171–0.969,
p
= 0.042). After adjustment for pre-defined variables, CAS was associated with a lower rate of 3 months’ mortality (aOR 0.430, 95% CI 0.187–0.989,
p
= 0.047) and a higher rate of complete recanalization (aOR 1.986, 95% CI 1.121–3.518,
p
= 0.019), successful recanalization (aOR 2.433, 95% CI 1.263–4.686,
p
= 0.008) and parenchymal hematoma (aOR 2.876, 95% CI 1.173–7.050,
p
= 0.021). CAS was associated with lower 3 months mortality (OR 0.373, 95% CI 0.141–0.982,
p
= 0.046) and higher rates of successful recanalization (OR 2.082, 95% CI 1.099–3.942,
p
= 0.024) after adjustment for variables associated with 3 months’ mortality and successful recanalization, respectively.
Conclusions
Among AIS patients with TO, CAS during EVT was associated with a higher rate of successful reperfusion and a lower rate of 3 months’ mortality.
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