Emergent Carotid Angioplasty or Stenting for Internal Carotid–Middle Cerebral Artery Tandem Occlusion Strokes: Real-World Outcomes in a Nationwide Cohort

BACKGROUND AND PURPOSE: While endovascular thrombectomy (EVT) of intracranial occlusions is currently guideline-recommended, whether additional emergent balloon angioplasty (BA) or carotid artery stent placement (CAS) is effective and safe for patients with internal carotid-middle cerebral artery tandem occlusion (TO) is less clear. This study evaluated the outcomes following EVT combined with BA versus CAS alone for patients with TO. MATERIALS AND METHODS: This was a retrospective cohort study of the Nationwide Readmissions database (2016-2022). Patients with ipsilateral ICA-MCA TO treated with EVT were identified, and stratified into 3 groups: EVT alone, EVT + BA, and EVT + CAS. The primary end point was the patient's functional status at the time of hospital discharge as an ordinal variable, ranging from functional independence to death. Secondary outcomes included in-hospital mortality and intracranial hemorrhage (ICH). Multivariable regression analyses adjusting for patient demographics, stroke severity, and comorbidities were used to account for confounding bias. RESULTS: = .06). CONCLUSIONS: Emergent EVT + CAS for patients with TO was associated with improved functional outcomes and reduced in-hospital mortality without significantly increasing the ICH risk.