Comparison of Functional Outcomes and Safety of Acute Carotid Stent Placement versus Thrombectomy Alone in the Treatment of Patients with Tandem Occlusions in Acute Ischemic Stroke.

PURPOSE: To compare functional outcomes and procedure-related complication rates between patients with tandem occlusions (TOs) treated with endovascular thrombectomy (EVT) plus extracranial internal carotid artery stent placement (ES) and those treated with EVT alone (EVT-A).

MATERIALS AND

METHODS

This retrospective cohort study was conducted between October 2016 and June 2025. All patients with TOs treated with endovascular therapy were included. Data were obtained from an anonymized clinical database of the Interventional Radiology Service at a high-complexity referral center in Colombia.

RESULTS

A total of 66 patients with TOs were identified; 21 underwent acute carotid stent placement (CAS), and 45 were treated with EVT alone. CAS (ES) group achieved higher rates of excellent reperfusion (Thrombolysis in Cerebral Infarction scale of 2c-3, 76% vs 47%; P = .024). Modified Rankin Scale score of 0-2 was more frequent with CAS (42.9% vs 17.8%, P = .03), with significantly lower mortality (19% vs 51%, P = .013). CAS was associated with higher odds of successful reperfusion (odds ratio [OR], 3.65; 95% CI, 1.14-11.69; P = .029), whereas baseline higher National Institutes of Health Stroke Scale score was negatively associated with functional independence (adjusted OR, 0.82; 95% CI, 0.73-0.92; P = .002). The crude association between carotid ES group and functional outcome was not maintained in the multivariable analysis (adjusted OR, 2.07; 95% CI, 0.58-11.62; P = .211). Safety analysis demonstrated no increase in hemorrhagic complications.

CONCLUSIONS

Extracranial CAS was associated with higher rates of successful reperfusion without an increased risk of hemorrhagic complications. Associations with functional outcomes observed in crude analyses were not maintained after multivariable adjustment. This provide evidence from a Latin American cohort, supporting CAS as a safe and effective strategy.