Clinical Outcomes and Predictive Factors in Acute Tandem Occlusion: A Single-Center Experience

Objective: To evaluate treatment outcomes and analyze predictive factors associated with favorable outcomes in patients with acute tandem occlusion (TO) stroke who underwent mechanical thrombectomy (MT) at a single, high-volume center. Materials and Methods: This retrospective study analyzed patients with anterior circulation stroke who underwent MT between January 2010 and December 2023. Ninety-two patients with TO, defined as severe stenosis (>70%) or occlusion of the cervical internal carotid artery (c-ICA) with concurrent intracranial occlusion, were identified. The primary endpoint was a favorable functional outcome (modified Rankin Scale [mRS] 0–2) at 90 days. Multivariate logistic regression was performed to identify independent predictors. Results: Of 743 anterior circulation patients (651 single occlusion [SO], 92 TO [12.4%]), favorable outcomes were achieved in 55.4% of TO patients with a mortality rate of 9.8%, not significantly different from SO (58.0% favorable, 7.9% mortality; p=0.67) in unadjusted comparison. Multivariate analysis identified three independent predictors of favorable outcomes: age ≤65 years (OR 5.2, 95% CI 1.6–16.5, p=0.005), initial NIHSS ≤16 (OR 3.9, 95% CI 1.2–12.5, p=0.022), and successful recanalization (mTICI ≥2b) (OR 6.5, 95% CI 1.1–39.9, p=0.043). Conclusion: MT for acute TO yields outcomes comparable to SO in unadjusted analysis. Age ≤65 years, lower initial NIHSS, and successful recanalization are key predictors of favorable outcomes. Acute carotid stenting showed a trend toward better functional outcomes but was associated with higher hemorrhage rates; definitive conclusions require further investigation.