Introduction Mechanical Thrombectomy (MT) of the intracranial occlusion along with emergent carotid stenting (eCAS) has shown benefit in tandem lesions (TL) treatment, although there is incomplete agreement about the technical endovascular approach.

Aim of Study We sought to compare clinical and procedural outcomes associated with the two different treatment approaches in patients with TL: anterograde vs retrograde.

Methods Anterior circulation tandem lesions patients treated from January 2016 to June 2023 were divided on the basis of antegrade versus retrograde approach and included. The outcomes were favorable mRS score (mRS score 0-2) at 3 months, successful recanalization (TICI 2b-3), time from groin puncture to successful recanalization, procedure-related adverse events, stent thrombosis either within or after 24 hours and 90-day mortality.

Results 295 patients (87 antegrade and 208 retrograde approach patients) with acute stenting were collected. We used propensity score matching (PSM) to estimate differences in outcome measures between the two groups.A retrograde approach resulted in a shorter procedural time (71.8 ± 45.5 minutes versus 93.4 ± 45.5 minutes in the anterograde approach, p=0.017) and a higher rate of successful intracranial recanalization after MT (91.1% vs 73.21% in the anterograde approach, p=0.025). There were no significant differences in mRS score 0-2 at 90 days (57.14% vs 60.71%, p = 0.54) as well as the rates of procedure-related adverse events and of stent thrombosis, and mortality.

Conclusion The retrograde approach led to significantly faster recanalization times,, with a similar functional and safety profile when compared with the antegrade approach in patients with acute ischemic stroke with tandem lesions.

Disclosure of Interest no.