Introduction Tandem lesions (TL) with internal carotid artery stenosis and occlusion in the median meningeal artery stromal region are found in 15–30% of acute ischemic stroke cases, and medical treatment alone leads to poor outcomes in up to 80% of patients. Endovascular treatment (EVT) is the preferred therapy, however, optimal approach and predictive outcome variables remain unclear.

Aim of Study To analyse and assess predictive demographic, treatment and imaging features for TL patients‘ outcome.

Methods This retrospective, mono-centric cohort study analyses 116 consecutive patients with TL treated with EVT from 2009 to 2022 with individual inquiry of their clinical, imaging and outcome data at a stroke centre.

Results The patients were median 72 years old, among those, 31% female. The median NIHSS on admission was 14, while the ASPECT and NASCET scores were 9 and 99% respectively. 52% of patients received intravenous lysis therapy pre-interventional. In 77%, an antegrade EVT approach was used. Adequate revascularization (mTICI2b3) was achieved in 83% with a median of one pass, whilst a mRS-score from 0 to 2 was attained in 41%. However, the total mortality rate was high at 44%. Age, stroke severity (NIHSS at admission) and outcome factors showed significant correlations. Long-term mortality associates with neurological problems and diabetes mellitus separately.

Conclusion EVT for TL is safe and effective. Lower age and shorter procedural time both correlate with successful outcomes, but the fact that stroke severity, neurological issues and diabetes are linked to higher mortality shows the connotation of comorbidities with long-term survival.

Disclosure of Interest All authors:

Nothing to disclose