Abstract Number: Esoc2026a73 Endovascular Treatment of Tandem Occlusions in Anterior Circulation Stroke

Abstract Background and aims Approximately 15-20% of patients with anterior circulation acute ischemic stroke undergoing endovascular thrombectomy have tandem occlusion, defined as severe stenosis or occlusion of the cervical internal carotid artery (ICA) ipsilateral to an intracranial occlusion. Nevertheless, the necessity for acute cervical stenting is still unclear. Methods This prospective single-center study (S.S. Yudin State Clinical Hospital, Moscow; 2020–2025) enrolled patients with anterior circulation tandem occlusion treated with endovascular therapy. Following successful intracranial reperfusion (mTICI 2b/3), patients were stratified by cervical ICA management: emergent stenting or no stenting (with possible delayed revascularization). All received protocol-directed antiplatelet therapy. Outcomes were analyzed using logistic regression. Results A total of 99 patients were included, with 53 receiving emergent cervical ICA stenting. Early patency of the cervical ICA (within 24 hours) was more frequently observed in the stenting group. (98.1% vs. 67.4%; p 0.001). The stenting group also showed higher rates of post-ASPECTS24 ≥ 7 (73.6% vs. 39.1%; p 0.001), early neurologic improvement (Δ NIHSS1 ≥ 6; 67.9% vs. 34.8%; p 0.001), and substantial clinical improvement at day 7 (Δ NIHSS7 ≥ 9; 64.2% vs. 37.0%; p = 0.007). The frequency of favorable 90-day functional outcome, defined as mRS scores of 0–2, was higher in the stenting group (69.8% vs. 41.3%; p = 0.004). There were no significant differences in mortality and symptomatic intracerebral hemorrhage rates between the groups. Conclusions In patients with tandem occlusion, mechanical thrombectomy combined with emergent cervical ICA stenting demonstrates superior efficacy compared to a strategy of delayed revascularization. Conflict of interest Hayk Galustyan: nothing to disclose, Vitaly Sysoev: nothing to disclose, Alexander Faybushevich: nothing to disclose, Valery Almaev: nothing to disclose