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Background Stenting extracranial internal carotid artery (ICA) lesions in acute ischemic stroke with tandem lesions is technically challenging. Its safety is highly debated because of the requirement of dual‐antiplatelet therapy. The optimal stenting device, timing, and periprocedural antiplatelet therapy for extracranial ICA stenting in the setting of acute tandem occlusion are still unclear. Methods We performed a retrospective study of patients with acute ischemic stroke attributable to tandem lesions who underwent endovascular treatment during a 5‐year period receiving either conventional self‐expanding carotid stents (SX) or balloon‐expandable carotid stent (BX). BX stents were restented with an SX in the subacute phase. Primary outcomes of interest were extracranial ICA patency at follow‐up and symptomatic intracranial hemorrhage. Results A total of 112 patients admitted from April 2016 to April 2021 were included. Dual‐antiplatelet therapy immediately following endovascular treatment was more frequently administered in the SX group (35/39 [89.7%]) compared with the BX group (20/73 [27.4%]) (P

Background In the endovascular treatment of stroke, achieving complete recanalization in a minimum number of attempts is the main procedural objective. We aimed to explore the effect of the per pass recanalization pattern in patients with final complete recanalization. Methods We analyzed all patients admitted in our center from 2014 to 2022 with a terminal internal carotid artery or M1‐middle cerebral artery occlusion who received endovascular treatment and achieved complete recanalization (expanded thrombolysis in cerebral infarction 2c–3) in our center. Complete sudden recanalization (cSR) was considered when expanded thrombolysis in cerebral infarction improved from 0–1 to 2c–3 in a single pass as opposed to complete progressive recanalization when partial recanalization (2a or 2b) was observed after interim passes. Results Among the 400 included patients with final complete recanalization, 301 (75%) showed a cSR pattern. There were no differences in baseline demographic characteristics between patients with cSR and complete progressive recanalization, including intravenous tissue plasminogen activator treatment (42.2% versus 44.4%; P=0.69). The rate of terminal carotid artery occlusion (28.6% versus 44.4%; P=0.003), median number of passes (1 [interquartile range 1—2] versus 2 [2–3]; P2 passes: 63.6%; P=0.825). Conclusion Among stroke patients with a large vessel occlusion, the cSR pattern predicted favorable outcome independently of the number of thrombectomy passes.

Background Patients with acute ischemic stroke due to large vessel occlusion may present with concomitant carotid dissections that make the technical approach for their treatment challenging. The purpose of this study was to determine the safety and feasibility of flow diverter (FD) stents to treat carotid artery dissections in tandem lesions of acute ischemic stroke patients during mechanical thrombectomy. Methods A retrospective review of all patients in which a carotid artery dissection was treated with an FD during endovascular treatment of acute ischemic stroke between 2018 and 2020 was conducted in 5 high‐volume Comprehensive Stroke Centers. Patient clinical and angiographical characteristics, postoperative outcome, and follow‐up were recorded. Results A total of 12 patients (mean age: 54.18±14.74 years, median Alberta Stroke Program Early CT Score: 10 [interquartile range 9–10]) were included. Successful FD stenting with immediate patency of the dissected segments and successful intracranial recanalization modified thrombolysis in cerebral infarction score 2b‐3 after thrombectomy was achieved in all patients. A good outcome (modified Rankin scale 0–2 at 90 days) was achieved in 66% (8/12) of patients. In 25% (3/12) of patients, an additional self‐expanding carotid stent was used to anchor the FD proximally at the carotid bulb level. Complications included 1 symptomatic intracranial hemorrhage after procedure (24–48 hours) and 2 in‐stent stenoses at follow‐up. Conclusions In this small case series, the treatment of carotid artery dissection with FD stents was safe and technically feasible during mechanical thrombectomy of acute ischemic stroke patients with tandem lesions and resulted in a high rate of good clinical outcome. These results may provide the basis for designing larger prospective studies to assess the efficacy and safety of FD stents in selected patients with carotid tandem lesions.