Rescue carotid stenting in tandem occlusions: 5 years’ experience from a comprehensive stroke center

Abstract

Background and purpose: Rescue carotid stenting has recently been provided as an additional treatment followed by mechanical thrombectomy in patients with tandem occlusions of the anterior circulation. Nevertheless, few available data support the benefits of this treatment in Asia. We hypothesized that this treatment would be associated with improved postprocedural clinical outcomes. Methods: We retrospectively analyzed patients who underwent rescue carotid stenting for tandem occlusions of the anterior circulation between December 2020 and May 2024 at our hospital. Clinical, neuroimaging, procedural, and complication data were collected. Primary outcomes included the rate of good outcomes with the modified Rankin Scale (mRS) <_2 at 3-month follow-up. Results: Ninety patients with tandem occlusions of the anterior circulation who underwent rescue carotid stenting were included, all of whom achieved successful recanalization. Among the 80 cases with the distal-toproximal approach, diagnostic-Dotter was used in 85 %. Fifty-three patients (58.9 %) had good outcomes, and six patients (6.7 %) experienced parenchymal hemorrhage type II, which was associated with death (mRS 6) after the procedure. Conclusion: Placement of rescue carotid stenting in tandem occlusions was associated with improved clinical outcomes, without increasing symptomatic intracranial hemorrhage.