Abstract 504: Comparison of Functional Outcomes and Safety of Acute Extracranial Stenting Versus Angioplasty Without Stenting in Patients with Tandem Occlusions in Acute Ischemic Stroke

Objectives To compare functional outcomes and assess procedure‐related complication rates in patients with tandem occlusions treated with endovascular therapy, with or without stenting in the extracranial cervical segment of the internal carotid artery. Materials and Methods Retrospective cohort study conducted between October 2016 and June 2025. All patients with tandem occlusions treated with endovascular therapy were included. Data were obtained from an anonymized clinical database of the Interventional Radiology Service at Clínica Foscal and Clínica Foscal Internacional in Santander, Colombia. Results Of 66 patients with tandem occlusions, 21 underwent extracranial stenting and 45 were treated without stenting. Patients in the stent group achieved higher rates of successful reperfusion (TICI ≥2b: 100% vs 71%, p=0.006) and excellent reperfusion (TICI 2c‐3: 76% vs 47%, p=0.024). Functional independence at follow‐up (mRS 0‐2) was more frequent with stenting (42.9% vs 17.8%, p=0.03), with significantly lower mortality (19% vs 51%, p=0.013). Safety analysis showed no increase in intracranial hemorrhage, although periprocedural antiplatelet use was more common in the stent group. Conclusions Acute extracranial stenting in tandem occlusions was associated with higher successful reperfusion rates, better functional outcomes, and lower mortality, without increasing hemorrhagic complications. These findings support stenting as an effective and safe strategy.