Abstract Background Acute ischemic stroke (AIS) can be caused by multiple factors, including intracranial large vessel occlusion (LVO), severe stenosis or occlusion of the cervical carotid artery, or both (tandem lesion). The optimal treatment strategy for tandem lesions remains unclear. This single-arm retrospective study aims to measure outcomes for tandem lesion patients who were treated with emergency carotid artery stenting (eCAS) during endovascular treatment (EVT). Materials and methods Patients who underwent EVT including eCAS for AIS with tandem lesions during the period 2015–2023 at our community teaching hospital in Western Europe were analyzed. Primary outcome was modified Rankin Scale (mRS) at 90-day follow up. Secondary outcomes were mortality within 30 days after stroke, symptomatic intracranial bleeding within 30 days after the stroke, major complications, and angiographic scores. Results Of the 600 patients who were treated with EVT, 64 underwent 65 eCAS procedures. Preprocedural National Institutes of Health Stroke Scale (NIHSS) scores of these 64 patients ranged from 2 to 24 (median 13). Expanded treatment in cerebral infarction (eTICI) scores immediately postprocedural were 0 ( n = 1, 1.5%), 2a ( n = 6, 9.2%), 2b ( n = 31, 47.7%), 2c ( n = 6, 9.2%), or 3 ( n = 20, 30.8%). In 10.8% ( n = 7) of eCAS procedures, complications occurred during the procedure and in 18.5% ( n = 12) complications occurred during the follow-up period. In 9.2% ( n = 6) of procedures, patients experienced symptomatic intracranial bleeding. Intracranial bleeding was observed more frequently in patients with preprocedural internal carotid artery (ICA) occlusion than stenosis but the difference was not statistically significant. At 90 days follow-up, in 41.5% ( n = 27) of eCAS procedures, patients had an mRS score of ≤ 2. Binary logistic regression analysis revealed age and IV thrombolysis as significant predictors for death and age and a pretreatment low NIHSS score for a good functional outcome after 90 days (mRS 0–2). For bleeding complications none of the predictors reached statistical significance. Conclusions Emergency carotid artery stenting during EVT for tandem lesions appears feasible with acceptable functional outcomes, despite the occurrence of symptomatic intracranial bleeding in 9% of patients. We must however await the results of randomized controlled trials before firm conclusions about the safety of eCAS can be drawn.
Kaufmann et al. (Thu,) studied this question.