Endovascular treatment of a tandem lesion in the anterior circulation: results of the tandem MN study

Abstract Background Endovascular management of acute stroke caused by a tandem lesion in the anterior circulation is currently a discussed area. Acute insertion of a carotid stent in the absence of antiaggregation premedication often leads to acute stent occlusion with clinical impact. Conversely, early antiplatelet therapy after intravenous thrombolysis can lead to hemorrhagic complications. Early reocclusion may also occur if the carotid artery is left with residual stenosis for elective treatment. Our aim was to analyze the clinical outcome of patients with tandem lesions (TL). Results 1350 patients were included in the study. 225 patients underwent MT for a tandem lesion (age 70.8 ± 11.3 years, 52.4% men). Successful recanalization (TICI ≥ 2b) was achieved in 83.1% (79.9% at non TL group, p = 0,269). A good clinical outcome(mRS ≤ 2) was achieved by 54.7% of patients (43.4% at non TL group, p = 0,002). A relatively good clinical outcome (mRS ≤ 3) was achieved by 61.8% of patients (50% at non TL group, p = 0,001). Mortality (90 days) was 25.3% (34.6% at non TL group, p = 0,007). Conclusions A tandem lesion in the anterior circulation is a frequently feared finding in acute cerebrovascular accident. However, endovascular treatment can have a significantly good clinical result here as well. In our cohort, this is the subgroup with the best prognosis.