Background: Approximately 15-20% of patients undergoing endovascular thrombectomy for anterior circulation acute ischemic stroke have a tandem occlusion, defined as a severe stenosis or occlusion of the cervical internal carotid artery ipsilateral to its intracranial occlusion. Although intracranial thrombectomy represents the standard treatment approach for anterior circulation tandem occlusions, whether the cervical ICA requires emergent stenting remains unclear.

Objectives: The aim of this study was to determine if emergent stenting of the cervical ICA improves outcomes compared to delayed revascularization.

Methodology: This single-center prospective study, conducted from 2020 to 2025 at S.S. Yudin State Clinical Hospital in Moscow, included patients with anterior circulation tandem occlusion who were treated with endovascular therapy. Patients with successful intracranial reperfusion (mTICI 2b/3) were divided into groups based on cervical ICA treatment strategy: stenting versus no stenting, with the option of delayed revascularization. In both groups, patients received antiplatelet therapy according to the study protocol. Study outcomes were analyzed using logistic regression.

Key Results/Findings: A total of 99 patients were included, with 53 receiving emergent cervical ICA stenting. Early patency of the cervical ICA (within 24 hours) was more frequently observed in the stenting group. (98.1% vs. 67.4%; p < 0.001). The stenting group also showed higher rates of post-ASPECTS24 ≥ 7 (73.6% vs. 39.1%; p < 0.001), early neurologic improvement (Δ NIHSS1 ≥ 6; 67.9% vs. 34.8%; p < 0.001), and substantial clinical improvement at day 7 (Δ NIHSS7 ≥ 9; 64.2% vs. 37.0%; p = 0.007). The frequency of favorable 90-day functional outcome, defined as mRS scores of 0–2, was higher in the stenting group (69.8% vs. 41.3%; p = 0.004). There were no significant differences in mortality and symptomatic intracerebral hemorrhage rates between the groups.

Conclusion: Mechanical thrombectomy combined with emergent cervical ICA stenting provides superior treatment efficacy over delayed revascularization in acute ischemic stroke patients with tandem occlusion.

Galustyan Hayk is a practicing endovascular surgeon at the S.S. Yudin Moscow City Clinical Hospital. He holds a PhD degree, is an Assistant Professor at RUDN University, and is actively engaged in research, particularly in the field of neurointerventions.