Introduction Acute stroke treatment with intracranial thrombectomy and stent-PTA of ipsilateral carotid artery stenosis/occlusion (“tandem lesion’ TL) in one session is considered safe. However, the risk of stent restenosis after TL treatment is high. Antiplatelet (AP) therapy to prevent restenosis must be well balanced to avoid intracranial hemorrhage. We investigated the procedural safety and 90 days outcome of patients receiving TL treatment under triple-AP with a focus on stent-patency and possible disadvantageous comorbidities.

Aim of Study To ensure stent patency after TL treatment without putting the patient at risk of recurrent stroke or intracranial hemorrhage.

Methods Patients receiving TL treatment at our institution in the setting of acute stroke between 2013 and 2022 were analyzed regarding peri-/postprocedural safety and stent patency after 90 days. All treatments were with i.v. administration of eptifibatide and acetylsalicylic acid and one of the three drugs prasugrel, clopidogrel, or ticagrelor. Follow-up was done with duplex imaging at discharge and 90 days, with digital subtraction angiography upon suspected restenosis.

Results 176 patients were included. No periprocedural death occurred, periprocedural complications rate was 2.3%, in-hospital death rate 13.6%. 92.61% of patients maintained or improved the discharge mRS score at 90 days follow-up. 4.54% had an instent-restenosis within 90 days, no recorded comorbidity rendered significantly disadvantageous for stent patency.

Conclusion TL treatment under triple AP was safe in our experience, resulting in a low rate of restenosis and with favorable outcome in 92%. The influence of comorbidities on restenosis could be negligible within the described follow-up period.

Disclosure of Interest Philipp von Gottberg:

Nothing to disclose.

Ali Khanafer:

Nothing to disclose

Victoria Hellstern:

Proctering for phenox GmbH.

Alexandru Cimpocca:

Nothing to disclose.

Hans Henkes:

Proctoring for phenox GmbH, Co-Founder and Co-Owner of CONTARA GmbH