Abstract Number: Esoc2026lt83 Emergent Carotid Stenting in Tandem Occlusions With Exracranial Dissection: The Multicenter Ceres-Tandem Study

Background and aims Within the international CERES-TANDEM cohort, emergent carotid stenting (eCAS) during thrombectomy improved 90-day outcomes for anterior circulation tandem lesions overall. Whether this benefit extends to the subgroup with cervical carotid dissection remains uncertain. Methods This is a predefined CERES-TANDEM substudy including consecutive patients with extracranial carotid dissection–related tandem occlusions treated with endovascular thrombectomy at 49 comprehensive stroke centres worldwide (2018–2024). Patients were classified as eCAS (n=288) or no-stenting (n=194); IPTW balanced >20 baseline and procedural covariates, and the primary estimand was 90-day mRS shift. Secondary outcomes were good functional outcome (mRS 0–2), mortality, and safety; we also provide a meta-analysis of eCAS in dissection-related tandem occlusions, including multicentre studies with n>100 patients. Results Patients were middle-aged (median 55 years) with severe stroke at baseline (NIHSS 15–17) and similar imaging profiles across strategies. After IPTW, eCAS was associated with a non-significant trend toward lower disability (common OR 1.10, 95% CI 0.80–1.51) and no excess in sICH or mortality versus no-stenting. Distribution of 90-day mRS suggested numerically more favourable outcomes with eCAS, but good outcome did not differ significantly between strategies. In the updated meta-analysis (3 studies, 892 patients), eCAS yielded a marginal increase in good functional outcome (pooled OR 1.20, 95% CI 0.92–1.57). Conclusions In this CERES-TANDEM substudy, eCAS in cervical dissection–related tandem lesions conferred only a non-significant benefit on functional outcome after rigorous adjustment. Pooled evidence from our meta-analysis suggests a modest treatment effect that supports RCTs. Conflict of interest