Introduction The optimal endovascular treatment approach of acute tandem large vessel occlusion (TLVO) stroke remains unclear. Tenzing (Route 92 Medical, San Mateo, CA) delivery catheters have atraumatic tapered distal tips that may permit Dotter angioplasty and delivery of 0.070-0.088 catheters through cervical steno-occlusions to gain intracranial access for LVO thrombectomy.

Aim of Study We describe our initial experience using the novel Tenzing-Dotter technique in TLVO patients.

Methods We retrospectively reviewed clinical and angiographic data of consecutive TLVO patients treated with Tenzing-Dotter technique using Tenzing® 7 and Tenzing® 8 at our center.

Results Twenty TLVO patients were identified: mean age was 65(44 – 89); 40% female. The mean NIHSS was 14(7-25). The ipsilateral cervical ICA was occluded in 11/20(55%) or severely stenotic in 9/20(45%). The intracranial LVO were carotid terminus (5), M1 (14) and M2 (1). Seven patients were treated with Tenzing 7 paired with a 0.070’ catheter, while 13 were treated with Tenzing 8 paired with a 0.088’ catheter. Successful cervical lesion crossing was achieved in 100% using the Tenzing-Dotter delivery technique. Mean time from groin puncture to successful Tenzing-Dotter delivery was 11 minutes, and the mean time from groin puncture to device delivery to the intracranial occlusion was 15 minutes. TICI 2B or greater reperfusion was achieved in 100%, with a mean time to best TICI of 21 minutes. Mean cervical ICA stenosis improved from 97% to 67%. No symptomatic intracranial hemorrhage or cervical dissections were noted.

Conclusion The Tenzing-Dotter technique may be promising for safe and fast access for TLVO thrombectomy.