BACKGROUND
Patients with acute stroke due to tandem occlusion, the benefit of immediate revascularisation (stenting) of the cervical internal carotid artery (ICA) lesion during the endovascular thrombectomy (EVT) procedure is uncertain. We sought to determine current practice patterns and whether equipoise existed in a community of physicians with stroke expertise.
METHOD
We distributed an online survey to stroke experts affiliated with the Canadian Stroke Consortium, the Canadian Interventional Neuro Group, the Society of Vascular and Interventional Neurology and international ESCAPE trial collaborators. Questions were based on clinical scenarios and multiple-choice questions across a Likert-type scale were provided. The survey was sent out in September 2017. After two months, data were extracted and then analyzed using descriptive statistics. 
RESULTS
Responses from 162 stroke experts, primarily stroke physicians (N=65, 40.1%) and neuro-interventionalists (N=74, 45.7%), from Canada (N=95, 58.6%), the United States (N=42, 25.9%) and other countries (N=25, 15.4%) were analyzed. Over half (N=96, 59.7%) of respondents consider acute stenting of the cervical ICA as a treatment option (either rarely, occasionally, usually or always) versus 40,3% (N=66) who would never use it. Most respondents (N=113, 75%) agree that there exists equipoise or uncertainty regarding the optimal acute management of patients with tandem occlusion. A majority (N=88, 58.2%) of physicians surveyed would include patients in a trial addressing this question.
CONCLUSION
This survey shows high variability in practice regarding acute management of tandem lesions. The existence of community equipoise underscores the importance of a randomized clinical trial evaluating the benefit of acute ICA stenting in patients with tandem occlusion undergoing EVT.

MANAGEMENT OF PATIENTS WITH TANDEM CAROTID OCCLUSION UNDERGOING ENDOVASCULAR THROMBECTOMY FOR ANTERIOR CIRCULATION STROKE: AN INTERNATIONAL SURVEY OF STROKE PHYSICIANS