Objectives To assess the clinical outcome of major stroke secondary to tandem occlusions using extra-cranial internal carotid or vertebral artery stenting and mechanical thrombectomy (MT).

Methods In a retrospective analysis of our Stroke Thrombectomy database (n = 166), we identified 21 patients who underwent extra-cranial ICA or Vertebral artery (VA) stenting in conjunction with MT. 18 patients underwent extra-cranial ICA stenting for tandem ICA/MCA (TIM) occlusions and 3 patients had vertebral origin stenting for VA origin/basilar artery occlusions. We examined neurological improvement defined by ≥ 8 point reduction of National Institutes of Health Stroke Scale (NIHSS) score at 7 days and an improved modified Rankin Scale (mRS ≤ 2) score at 90 days. Successful recanalization based on thrombolysis in cerebral infarction (TICI) score of 2b or 3 was also evaluated.

Results 47.6% (n = 10) had a reduction in the NIHSS score by ≥ 8 points. 52.3% (11 patients) had a good outcome with a mRS ≤ 2. 90.4% (n = 19) achieved TICI 2b/3 signifying successful recanalization. Mortality was 19% (n = 4) with 3 deaths due to malignant MCA and 1 death due to pneumonia. No symptomatic intracranial hemorrhage was noted.

Conclusions Major Strokes due to TIM and VA origin/basilar occlusions can be successfully treated by extra-cranial internal carotid artery or vertebral artery stenting and mechanical thrombectomy (MT).

Advances in knowledge We favor the use of a hybrid approach in terms of the proximal-distal sequence as it achieves early cerebral recanalization and also reduces the procedure time.

This is one of the largest studies at present in the United Kingdom.

Disclosures S. Nayak: None. V. Leung: None. T. Woo: None. A. Sastry: None.