Abstract Number: Esoc2026a1379 Clinical Severity and Outcomes in Tandem Occlusion Stroke: The Role of Combined Reperfusion Strategies: A Single-Center Experience

Abstract Background and aims Tandem occlusions, involving simultaneous extracranial internal carotid artery (ICA) and intracranial large-vessel occlusions, are associated with high stroke severity and poor natural prognosis. Rapid and effective reperfusion is therefore critical to limit neurological damage. We aimed to assess the clinical impact of intravenous thrombolysis (IVT) prior to mechanical thrombectomy (MT) in patients with tandem occlusions. Methods We retrospectively analyzed all acute ischemic stroke patients treated with MT in 2025 at a comprehensive stroke center in Moldova. Of 213 thrombectomy cases, 31 (14.6%) had anterior circulation tandem occlusions and were treated with bridging therapy (IVT+MT, n=10) or direct MT (n=21). Neurological severity, reperfusion success, and 90-day functional outcomes were assessed using standard scales. Results Patients with tandem occlusions presented with high baseline neurological severity (NIHSS ≥15 in most cases). Successful reperfusion (mTICI ≥2b) was achieved in all patients, with complete reperfusion (mTICI 3) in 83.9% of cases and similar rates between bridging and direct MT groups. Both strategies led to marked neurological improvement, with most patients improving ≥8 NIHSS points at discharge. At 90 days, 71.0% of patients achieved favorable outcomes (mRS 0–2), with no meaningful difference between strategies. Poor outcomes were associated with very high baseline NIHSS or incomplete reperfusion. Conclusions Tandem occlusion strokes require urgent and complex reperfusion strategies. In our experience, bridging therapy with IVT prior to MT achieved high reperfusion rates, but did not confer additional functional benefit compared with direct thrombectomy. Larger prospective studies are needed to better define the role of combined reperfusion approaches. Conflict of interest Stupac Tatiana: nothing to disclose