{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T12:16:32Z","timestamp":1788869792674,"version":"build-2803163510"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["SVIN"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Tandem lesions (TLs) are a subtype of acute ischemic stroke, which involve an extracranial carotid lesion (ie, severe carotid stenosis \u226570%) with large vessel occlusion. While large vessel occlusion has a standard approach with mechanical thrombectomy (MT), the best practice for intervention of the carotid lesion is not well-established. Utilizing data from the ASSIST registry, we investigated the differences in clinical and procedural outcomes between acute versus nonacute stenting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>The ASSIST registry (an international acute ischemic stroke MT prospective study) was utilized to identify the subgroup of patients with acute ischemic stroke secondary to TL who received MT. The TLs were grouped by MT+acute carotid stenting (CAS) versus MT+acute carotid nonstenting. The demographics and clinical outcomes (90-day modified Rankin Scale score) were compared between TL and non-TL groups, and between MT+CAS and MT+acute carotid nonstenting. Multivariable analyses were performed to determine independent predictors of clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      A total of 183 of 1270 (14.4%) TLs were identified in the ASSIST registry. MT+CAS was performed in 83 of 183 (45.4%) subjects, and 100 of 183 (54.6%) received MT+acute carotid nonstenting. There are no significant differences at baseline between the 2 groups in the National Institutes of Health Stroke Scale score, Alberta Stroke Program Early Computed Tomography Score, or target vessel. Achieving a modified Rankin Scale score of 0 to 2 at 90 days was 70.9% in the MT+CAS group versus 48.9% in the MT+acute carotid nonstenting group (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.001), with a modified Rankin Scale score of 0 to 2 being significantly associated with the MT+CAS group in multivariable analysis (odds ratio, 2.14 [95% CI, 1.01\u20134.51]). There was no significant difference in mortality or symptomatic intracerebral hemorrhage between the groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>In acute ischemic stroke, secondary to TLs treatment with thrombectomy and acute carotid stenting is associated with improved 90-day functional outcome without an increase in symptomatic intracerebral hemorrhage compared with no acute stenting approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT03845491.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/svin.125.002157","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T09:02:00Z","timestamp":1773997320000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical and Angiographic Outcomes in Patients With Tandem Occlusion Thrombectomy: Analysis From the ASSIST International Registry"],"prefix":"10.1161","volume":"6","clinical-trial-number":[{"clinical-trial-number":"nct03845491","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3380-434X","authenticated-orcid":true,"given":"Yazan","family":"Ashouri","sequence":"first","affiliation":[{"name":"Department of Neuroscience, Bon Secours Mercy Health St. Vincent Medical Center, Toledo, OH (Y.A., M.A., J.M.O., A.C., E.L., O.O.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5051-6687","authenticated-orcid":true,"given":"Mohammad","family":"AlMajali","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Bon Secours Mercy Health St. Vincent Medical Center, Toledo, OH (Y.A., M.A., J.M.O., A.C., E.L., O.O.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8151-5468","authenticated-orcid":true,"given":"Jasmine M.","family":"Olvany","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Bon Secours Mercy Health St. Vincent Medical Center, Toledo, OH (Y.A., M.A., J.M.O., A.C., E.L., O.O.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Chaudhari","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Bon Secours Mercy Health St. Vincent Medical Center, Toledo, OH (Y.A., M.A., J.M.O., A.C., E.L., O.O.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvador","family":"Miralb\u00e9s","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Hospital Son Espases, Mallorca, Spain (S.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0322-5824","authenticated-orcid":true,"given":"Bharath","family":"Naravetla","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Interventional Neurology, McLaren Regional Medical Center, Flint, MI (B.N.)."},{"name":"Department of Neuroscience, Interventional Neurology, McLaren Regional Medical Center, Macomb, MI (B.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Spiotta","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical University of South Carolina, Charleston (A.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0191-1602","authenticated-orcid":true,"given":"Eugene","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Bon Secours Mercy Health St. Vincent Medical Center, Toledo, OH (Y.A., M.A., J.M.O., A.C., E.L., O.O.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7572-9734","authenticated-orcid":true,"given":"Christian","family":"Loehr","sequence":"additional","affiliation":[{"name":"Department of Radiology and Neuroradiology, Klinikum Vest Recklinghausen, Germany (C.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8024-4712","authenticated-orcid":true,"given":"Mario","family":"Mart\u00ednez-Gald\u00e1mez","sequence":"additional","affiliation":[{"name":"Department of Radiology, Interventional Neuroradiology\/Endovascular Neurosurgery, Hospital Cl\u00ednico Universitario de Valladolid, Spain (M.M.-G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5853-5161","authenticated-orcid":true,"given":"Ryan","family":"McTaggart","sequence":"additional","affiliation":[{"name":"Department of Radiology, Interventional Neuroradiology, Rhode Island Hospital, Providence (R.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5814-2798","authenticated-orcid":true,"given":"Luc","family":"Defreyne","sequence":"additional","affiliation":[{"name":"Department of Vascular and Interventional Radiology, Ghent University Hospital, Belgium (L.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7446-4540","authenticated-orcid":true,"given":"Pedro","family":"Vega","sequence":"additional","affiliation":[{"name":"Department of Radiology, Hospital Universitario Central de Asturias, Oviedo, Spain (P.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5354-1636","authenticated-orcid":true,"given":"Varun","family":"Chaubal","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, HCA Houston Healthcare, TX (V.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Jenkins","sequence":"additional","affiliation":[{"name":"Division of Neurovascular, Stryker Neurovascular, Fremont, CA (P.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5109-8736","authenticated-orcid":true,"given":"David S.","family":"Liebeskind","sequence":"additional","affiliation":[{"name":"Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles 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PICASSO (Proximal internal carotid artery acute stroke secondary to tandem or local occlusion) thrombectomy trial: study protocol and rationale. 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