MANAGEMENT OF ACUTE STROKE DUE TO TANDEM OCCLUSIONS WITH CAROTID STENTING AND INTRACRANEAL THROMBECTOMY. 
Background and Aims
The management of tandem occlusion represents a major challenge in patients with acute ischemic stroke (AIS), we want to present our results in patients with AIS due to tandem occlusions treated with Mechanical Thrombectomy (TM) and acute carotid stenting. 
METHODS:
We performed a retrospective review of our prospective maintained, single-institution database between December 2014 and December 2017. We analyzed demographic, radiological, and clinical outcome data for patients who underwent endovascular treatment for tandem occlusion with acute carotid stenting.  A modified Rankin Scale score (mRs) ≤2 at 90 days was defined as a favorable clinical outcome. 
RESULTS: 
Thirty- four patients were identified for inclusion in the study, the average age of these patients was 61.7 years; the mean National Institutes of Health Stroke Scale score (NIHSS) at presentation was 16. 
Twenty three patients received intravenous thrombolisis before undergoing endovascular treatment (68%). The stroke etiology was mainly atherothrombotic (77%). All our endovascular treatments were complete with general anesthesia. The median time from groin to revascularization was 64.5 minutes (IQR 45.25-90). Successful reperfusion rate (modified Thrombolysis In Cerebral Infarction score ≥2b) was obtained in all but one of our patients (97%).  The rate of symptomatic intracranial hemorrhage (SICH) was 6%.
The mean NIHSS score were 8 points at 24h postprocedure and 4.5 points at discharge. Good outcome was achieved in 50% of the patients. 
CONCLUSIONS: 
In our center the management of tandem occlusions with acute carotid stenting involves good outcome and a low rate of SICH in accordance to the frequency found in similar case series.