Stenting Versus Non-stenting Strategy in Endovascular Treatment of Acute Anterior Ischemic Stroke Patients with Tandem Occlusion.

Background and objectives: The optimal endovascular treatment (EVT) strategy for acute tandem occlusion patients has not been decided yet, and a knowledge gap still exists in the literature. Therefore, we aimed to compare the two different interventional strategies, stenting and non-stenting, for the treatment of acute tandem occlusion patients.

Methods: This was a single-center, retrospective, observational cohort study, which was conducted in a tertiary referral center. We reviewed all acute stroke patients between January 2016 and January 2024. We assessed the effects of the two strategies, stenting and non-stenting, on seven outcome measures, namely: hemorrhagic transformation after EVT, number of days in the neurology intensive care unit (N-ICU), number of days in the hospital, in-hospital mortality, functional outcome at discharge, 3-month functional outcome, and 3-month mortality.

Results: We included 54 acute tandem occlusion patients who were treated with EVT in the study. Thirty-five (64.8%) patients underwent emergency carotid stenting during EVT and 19 patients (35.2%) did not receive emergency carotid stenting. Hemorrhagic transformation after EVT, number of days in N-ICU, number of days in the hospital, in-hospital mortality, functional outcome at discharge, and 3-month functional outcome did not differ between the two groups ( P > 0.05). Emergency stenting during EVT significantly reduced the probability of 3-month mortality (odds ratio = 0.21, confidence interval: 0.04 to 0.96, P = 0.04).

Conclusions: This study showed that emergency stenting in the acute tandem occlusion patients decreased the probability of mortality. Further research is needed on this.