Introduction Recent randomized clinical trials which demonstrated efficacy of endovascular treatment of large vessel occlusions in acute ischemic stroke did not include patients with tandem extracranial/intracranial arterial occlusions. These occlusions present unique treatment challenges due to complex endovascular approach. We report our experience in treating this cohort of acute stroke patients with the analysis of angiographic and clinical outcomes

Methods Retrospective review of clinical and imaging data of all consecutive acute stroke patients admitted between February 2011 and December 2014 at two hospitals. Patients with proximal intracranial arterial occlusion and additional extracranial occlusion/critical stenosis treated acutely with endovascular techniques. Both anterior as well as posterior circulation tandem occlusions were included. Analysis included demographics, clinical presentation, treatment strategies, time to recanalization, imaging and clinical outcomes

Results A total of 88 patients with tandem occlusions were treated acutely, 81 (92%) in the anterior circulation, and 7 (8%) – in the posterior. Mean procedure time was 102 min; Monitored Anesthesia Care (MAC) was used in 59% of the (52/88) procedures. Thrombolysis in Cerebral Infarction (TICI) ≥ 2B reperfusion was achieved in 91% of all the patients (80/88) overall and in 96% (55/57) of those treated with new endovascular techniques. Extracranial lesion was treated with stent placement in 67% of the cases (59/88), usually after intracranial thrombectomy. Good clinical outcome at 90 days (mRS≤2) was achieved in 45% of the patients (38/84, four patients were lost to follow-up). Symptomatic intracerebral hemorrhage occurred in 11% (10/88) of the patients

Conclusion Endovascular treatment of tandem arterial occlusions in acute ischemic stroke is feasible, safe, and yields excellent angiographic and good clinical outcomes

Disclosures M. Grigoryan: None. D. Haussen: None. A. Lima: None. J. Grossberg: None. A. Anderson: None. S. Belagaje: None. F. Nahab: None. M. Frankel: None. R. Nogueira: 2; C; Covidien, Steering Committee for the SWIFT and SWIFT Prime Trials and Core Lab for the STAR Trial, Stryker, PI for the TREVO-2 and DAWN Trials, Penumbra, Executive Committee for the 3D Separator Trial.