Background: Tandem internal Carotid Artery (ICA) lesions account for 15–30% of all acute ischemic strokes (AIS) caused by large intracranial artery occlusion, according to various studies. However, the optimal revascularization strategy for this patient cohort remains uncertain due to the lack of randomized controlled trials and warrants further investigation.

Aim of the study: This study aims to investigate the efficacy and safety of different endovascular treatment approaches for patients with acute ischemic stroke (AIS) caused by tandem internal carotid artery (ICA) lesions.

Material and methods: The study enrolled 94 patients with acute ischemic stroke (AIS) due to tandem internal carotid artery (ICA) lesions who achieved successful intracranial reperfusion (mTICI 2b–3). Following reperfusion, patients were allocated to two groups. The intervention group (n=48) underwent immediate stenting of the extracranial ICA lesion accompanied by administration of loading doses of dual antiplatelet therapy. The control group (n=46) received guideline-directed optimal medical therapy, including antiplatelet agents. In this group, revascularization of the extracranial ICA was deferred and considered only for patients who subsequently achieved a favorable functional outcome, defined as a modified Rankin Scale (mRS) score of 0–2. Data analysis was conducted using Stattech software.

Results: A favorable functional outcome (mRS 0–2) at 90 days was significantly more frequent in the intervention group than in the control group (64.6% vs. 41.3%, p=0.024). Similarly, early patency of the extracranial ICA was higher in the intervention group (89.6% vs. 67.4%, p=0.009). The rates of symptomatic intracerebral hemorrhage were comparable between groups (6.2% vs. 4.3%, p=1.000). Mortality was numerically higher in the control group (19.6% vs. 10.4%), but this difference did not reach statistical significance (p=0.255). Importantly, patients who achieved early extracranial ICA patency were significantly more likely to have a favorable functional outcome (p=0.019) and significantly less likely to die within three months (p=0.032).

Conclusion: This study demonstrated that the combined endovascular strategy of intracranial mechanical thrombectomy and urgent extracranial internal carotid artery stenting is associated with superior clinical efficacy in patients with acute ischemic stroke due to tandem lesions.

Hayk Galustyan completed his PhD at the age of 31 from the Peoples' Friendship University of Russia (RUDN University), Russian Federation. He is an endovascular surgeon at the Moscow City Hospital named after S.S. Yudin and an assistant professor at the Department of Hospital Surgery with a Course in Pediatric Surgery of RUDN University. He is actively engaged in research, with his primary scientific focus on the endovascular treatment of patients with ischemic stroke