Background
Endovascular therapy (EVT) is associated with improved clinical outcomes in patients with anterior circulation stroke due to tandem occlusion, defined as ipsilateral severe stenosis or occlusion of the cervical internal carotid artery (ICA) and occlusion of the distal ICA and/or middle cerebral artery (MCA). However, the role of immediate stenting of the cervical ICA is controversial. Our aim was to compare functional outcomes between patients with and without acute cervical ICA stenting during EVT for anterior circulation stroke.

Methods
We included all patients with tandem occlusions admitted to CHUM Notre-Dame Hospital for EVT between December 2014 and December 2016. Baseline characteristics (demographics, co-morbidities, baseline NIHSS, intracranial occlusion site, ICA pathology, IV thrombolysis,) were compared between patients having undergone acute ICA stenting or not. Our primary outcome was the proportion of patients with modified Rankin scale (mRS) 0-2 at 90 days. Secondary outcomes were: rate of symptomatic intracranial hemorrhage (sICH) and rate of post-EVT intracranial recanalization (TICI score 2b-3) and cervical ICA recanalization. 

Results
Seventy-three patients were included, of whom 26 underwent acute ICA stenting versus  47 who did not. There was no significant difference (p>0.05) in baseline characteristics between the two groups except for hypertension (77 vs 45%, p=0.008). The stenting group was associated with a higher rate of cervical ICA recanalization (92 vs 9%, p<0.0001) but no difference in intracranial recanalization (TICI 2b-3: 77 vs 79%, p=1.00). Although a greater proportion of patients undergoing acute ICA stenting had a favourable outcome at 90 days (mRS 0-2: 50 vs 44.2%), this difference was not statistically significant (p=0.64).

Conclusions
In our single-centre, non-randomized, retrospective study, patients with tandem occlusion treated with EVT for anterior circulation stroke had no significant difference in functional outcome, intracranial recanalization or sICH whether they underwent acute cervical ICA stenting or not. In light of our results and those of others, defining the role of acute ICA stenting in patients with stroke due to tandem occlusion will require a well-designed randomized controlled trial.

ACUTE CERVICAL CAROTID STENTING IN PATIENTS WITH TANDEM OCCLUSIONS: A RETROSPECTIVE SINGLE-CENTRE STUDY