Abstract WP057: Outcomes with Endovascular Treatment of Acute Ischemic Stroke due to Tandem Occlusions in the Anterior Circulation – A Single Center Experience

Background/Objectives: In a prior study of patients who underwent emergent carotid stenting at our comprehensive stroke center, an association between infarct size, quantified with Alberta stroke program early CT score (ASPECTS) score on initial CT, and symptomatic intracranial hemorrhage (ICH) was observed. Symptomatic ICH was, in turn, associated with mortality. We hypothesized that among patients with tandem occlusions, patients with ASPECTS score less than 8 would have higher incidence of symptomatic ICH. We also compared outcomes in endovascular treatment of acute ischemic stroke with tandem occlusions in the anterior circulation between carotid revascularization with stenting and with angioplasty alone. Methods: Retrospective study of adult patients with tandem occlusions in the extracranial internal carotid artery and distally in the intracranial carotid artery, middle cerebral artery, or anterior cerebral artery who underwent mechanical thrombectomy of intracranial large vessel occlusion (LVO) with emergent carotid angioplasty or stenting. Data including initial NIH Stroke Scale Score (NIHSS), ASPECTS score on initial CT, modified Rankin Scale (mRS) scores at baseline and at discharge, and occurrence of symptomatic ICH, defined as ICH with resultant greater than 4-point increase in NIHSS, were collected. Outcome measures included symptomatic ICH, favorable outcome at discharge, defined as discharge mRS of 0-2, and mortality. Results: A total of 31 patients, of whom 24 underwent stenting and 7 had angioplasty alone, were included. Symptomatic ICH occurred in 9 patients, and 11 had favorable outcome at discharge. Median ASPECTS score was 9 (range 5 - 10). Multivariate analyses showed no significant difference in rates of symptomatic ICH between stenting and angioplasty alone (OR: 0.037, p=0.106); no significant association between ASPECTS score and symptomatic ICH (OR 3.137, p=0.066); or between symptomatic ICH and mortality. Conclusion: Carotid stenting and angioplasty alone had comparable outcomes in patients with tandem occlusions undergoing thrombectomy. While infarct size showed a non-significant trend toward predicting symptomatic ICH, neither revascularization approach clearly altered the risk of ICH, favorable discharge outcome, or mortality. The current sample is underpowered, and we will continue to collect data to study outcomes in patients with large-core infarcts. Randomized trials are required to guide optimal management.