ABSTRACT NUMBER: ESOC2026LB22LB22 - CAROTID ARTERY STENTING DURING ENDOVASCULAR TREATMENT OF ACUTE ISCHEMIC STROKE (CASES)

Abstract Background and aims The optimal acute management of patients with tandem lesion (TL), defined as an intracranial large vessel occlusion (LVO) with concomitant carotid artery stenosis (≥50%) or occlusion, remains unclear. We aimed to assess the efficacy and safety of immediate carotid artery stenting (CAS) compared to deferred management in patients undergoing endovascular treatment (EVT) for acute ischemic stroke due to tandem lesions. Methods We did an open-label, international, multi-centre, randomised controlled trial in 27 centres in the Netherlands and Belgium. We enrolled adult patients with ischemic stroke due to a tandem lesion, who were eligible for EVT. Patients were randomly assigned (1:1) to CAS or deferred treatment strategy (CEA, delayed CAS, and/or best medical management). The primary outcome was modified Rankin Scale score at 90 days. Symptomatic intracranial haemorrhage was the main safety outcome. Statistical analyses were performed according to the per-protocol (PP) principle as well as the intention to treat (ITT) principle. Results A total of 633 patients were included between 2023 and 2025. Data collection is ongoing and results will be presented at the time of the conference. Conclusions We anticipate that this study will provide real-world insights into the safety and efficacy of immediate CAS during EVT in tandem lesion patients, informing guideline recommendations. Conflict of interest