Comparing Carotid Artery Stenting and Mechanical Thrombectomy for Stroke Treatment

Introduction Tandem lesion strokes (TLS), defined as simultaneous intracranial large‐medium‐vessel occlusion (LVO/MeVO) and cervical internal carotid artery (ICA) stenosis or occlusion, represent 10‐20% strokes. They are associated with poorer outcomes, reduced recanalization rates, higher disability and increased mortality. Therapeutic strategies vary between emergent carotid artery stenting during mechanical thrombectomy (eCAS) and mechanical thrombectomy alone (MTa). We aim to assess the safety and efficacy of eCAS versus MTa approach in patients presenting with anterior circulation TLS at a single comprehensive stroke center in Argentina. Methods Retrospective, observational, cross‐sectional study analyzed consecutive patients with anterior circulation TLS within 24 hours of symptoms onset treated between 2015 and 2025. Primary efficacy outcomes: ordinal shift in 90‐day mRS score, mRS 0‐1 and mRS 0‐2 at 90 days. Secondary efficacy outcome: successful recanalization (TICI 2b or higher) Primary safety outcomes: sICH, in hospital mortality and mortality at 90 days. Secondary safety outcomes: early neurological deterioration (increase of 4 NIHSS points within 24 hours) and in hospital ipsilateral recurrent ischemic stroke. Results A total of 109 patients (mean age 70.3 ±13 years, 63% male) were included: 72 treated with eCAS and 37 with MTa. Compared to MTa group, patients in the eCAS group presented lower median (IQR) NIHSS at admission (15 vs 17, p= 0.025), presented less M1 occlusion (18.1% vs 32.4%, p= 0.009), received more frequently intra‐arterial thrombolysis (13.8% vs. 0%, p = 0.029) and achieved higher rates of successful recanalization (97.2% vs. 78.4%, p = 0.001). In the perioperative setting, MTA group received more intravenous antithrombotic drugs (specially tirofiban) (61.1% vs 8.1%, p < 0.00001) and dual antiplatelet therapy (DAPT) (63.9% vs 2.7%, p <0.00001) and were more often treated with DAPT (75% vs. 29.7%, p < 0.00001) and less likely to receive direct oral anticoagulants at discharge (1.4% vs. 10.4%, p = 0.044). Efficacy and safety outcomes are presented in table 2. Shift in mRS scores at 90 is represented Figure 1 Conclusion Findings suggest that eCAS during thrombectomy may improve functional outcomes and recanalization without increasing hemorrhagic risk, supporting its potential as a safe and effective approach in TLS management.