Cervical Lesion Etiology Affects Clinical Outcomes After Endovascular Treatment for Tandem Lesions

Introduction Tandem lesions (TLs) are characterized by the simultaneous presence of an intracranial large vessel occlusion and a steno‐occlusive lesion of the ipsilateral cervical artery, most commonly of dissection or atherosclerotic etiology. The impact of the underlying cervical lesion etiology on outcomes after endovascular treatment (EVT) remains unclear. This meta‐analysis sought to compare angiographic and clinical outcomes following EVT between patients with atherosclerosis versus dissection of the cervical artery. Methods A comprehensive literature search was conducted across PubMed, Embase, and Cochrane databases through September 2025. Studies comparing the outcomes following EVT between TL patients with atherosclerosis versus dissection of the cervical artery were included. Outcomes of interest included successful recanalization (mTICI ≥2b), symptomatic intracranial hemorrhage (sICH), good outcomes (modified Rankin Scale [mRS] 0‐2 at 90 days), and mortality at 90 days. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random‐effects model, with heterogeneity assessed by I 2 statistics. Results Nine studies (n = 1,654; 392 dissection; 1,262 atherosclerosis) were included. The rate of successful recanalization did not differ significantly between groups (OR: 0.95, CI 0.68‐1.32; p = 0.71; I 2 = 11%). Similarly, no significant differences in sICH were observed between the two groups (OR: 0.81, CI 0.49‐1.34; p = 0.41; I 2 = 0%). However, patients with dissection‐related TLs were observed to have significantly higher odds of achieving good outcomes (OR: 1.85; CI: 1.42‐2.40; p = 0.0006; I 2 = 0%) and lower odds of mortality at 90 days (OR: 0.43; CI 0.28‐0.65; p < 0.001; I 2 = 0%). Conclusion Dissection‐related TLs are associated with significantly better functional outcomes and lower mortality compared to atherosclerosis‐related TLs in patients undergoing EVT. While angiographic and safety outcomes were comparable, these findings highlight the prognostic relevance of the etiology of TLs and warrant further investigation. image image