Background In acute ischemic stroke patients with tandem occlusion, internal carotid artery (ICA) acute angioplasty and stenting with contemporaneous intracranial reperfusion treatment may increase recanalization success rates. However, there is reluctance in undertaking acute stenting in the treatment of patients with tandem occlusions due to the possible increased risk of symptomatic intracerebral hemorrhage (SICH).

Purpose This retrospective study aims to determine the effects of cervical ICA angioplasty with or without contemporaneous carotid artery stenting in patients with tandem occlusion.

Methods We undertook a retrospective analysis of 9 patients with tandem occlusions who were treated endovascularly at Riverside Regional Medical Center between July 2012 and Dec 2017, of whom 6 received acute angioplasty and stenting (CAS) to treat the extracranial occlusion, and 3 received angioplasty alone (plasty only). Intracranial occlusions were treated with mechanical thrombectomy. Collected clinical endpoints included TICI score, discharge NIHSS score, discharge destination, and 90 day mRS score.

Results The CAS and plasty only groups had successful recanalization rates (TICI 2b or 3) of 100% and 67%, respectively. All plasty only patients were discharged to rehabilitation facilities and 3 (50%) of CAS patients were discharged to rehab while the remaining 3 were discharged directly home. A 90 day post-procedure mRS of ≤1 was observed for 3 CAS patients (50%) and none for plasty only patients.

Conclusions This retrospective study demonstrates the potential for safe treatment of tandem occlusion with acute cervical ICA angioplasty and stenting vs angioplasty alone in carefully selected patients, with the former associated with better outcomes in our cohort.

Disclosures P. Ramakrishnan: None. K. Holston: None. W. Leesch: 1; C; Penumbra, Stryker, Medtronic. 3; C; Penumbra. 6; C; Cerebrotech Inc. J. Sanderson: None. M. Gossage: None. D. Kostov: None.