{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T08:37:12Z","timestamp":1794472632253,"version":"4.9.1"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T00:00:00Z","timestamp":1743552000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Antithrombotic therapy of acute stroke patients with tandem lesions and emergent carotid artery stenting (CAS) is still a matter of controversial debates. The lack of evidence from dedicated studies favors a variety of clinical practices. The aim of this study was to use German Stroke Registry (GSR) data of selected high-volume centers to analyze the spectrum of antithrombotic regimens and their influence on complication rates and clinical outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed the GSR-subgroup of patients with tandem lesions treated with a combination of thrombectomy and carotid artery stenting between 2015 and 2020 in experienced stroke centers which included all consecutive cases, and which were willing to share clinical records in addition to registry data. Statistical analyses of kind and onset of CAS-specific antiplatelet therapy (APT) were used to determine the influence of dual APT (DAPT) on clinical outcome and stent-related complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 223 patients with tandem lesions treated by stenting and thrombectomy were included. In the periinterventional phase 68 patients (30.5%) had an aggressive DAPT with double antiplatelets (DAPT; 23.7%) given via gastral tube or with GPIIb-IIIa inhibitors intravenously as bridging (13.9%). In the post-interventional phase, the rate of DAPT increased from 38.6% on day one to 65% from day two. Already on day one, the effect of DAPT on the rate of good clinical outcome mRS (modified Rankin Scale) 0\u20132 at 90\u202fdays (<jats:italic>n<\/jats:italic>\u202f=\u202f86\/223; 38.5%) was significant (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.007), and compared with other APT regimens early continuous DAPT from the first postinterventional day increased the odds up to 79.4% (<jats:italic>n<\/jats:italic>\u202f=\u202f27\/34). DAPT during hospitalization showed no increased risk of symptomatic hemorrhage, while post-hospital use reduced stent occlusion (<jats:italic>p<\/jats:italic>\u202f=\u202f0.016).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Only a minority of the examined GSR patients with tandem lesions had an effective APT during the periinterventional phase up to day 1. Early postinterventional DAPT significantly increased the rate of good clinical outcome and reduced the rate of occlusive stent thrombosis without increasing risks of symptomatic hemorrhage. The apparent lack of standards and moderate rates of good clinical outcomes shows room for improvement and the necessity of further studies.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2025.1554691","type":"journal-article","created":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T07:43:47Z","timestamp":1743579827000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Safety, efficacy and timing of antithrombotic therapy in emergency stenting of acute stroke patients with tandem lesions, German multicenter data-analysis"],"prefix":"10.3389","volume":"16","author":[{"given":"Fee","family":"Keil","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Stahn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ferdinand O.","family":"Bohmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Samp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonhard","family":"Mann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas","family":"Bersch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waltraud","family":"Pfeilschifter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Bode","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marios-Nikos","family":"Psychogios","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan-Hendrik","family":"Schaefer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Grefkes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elke","family":"Hattingen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim","family":"Berkefeld","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe T.","family":"Arendt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"German Stroke Registry \u2013 Endovascular Treatment (GSR-ET) Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,4,2]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1723","DOI":"10.1016\/S0140-6736(16)00163-X","article-title":"Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials","volume":"387","author":"Goyal","year":"2016","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"801","DOI":"10.3238\/arztebl.2020.0801","article-title":"Diagnosis, treatment and follow-up in extracranial carotid stenosis","volume":"117","author":"Eckstein","year":"2020","journal-title":"Dtsch Arztebl Int"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1136\/neurintsurg-2020-015817","article-title":"Acute carotid stenting in patients undergoing thrombectomy: a systematic review and meta-analysis","author":"Dufort","year":"2021","journal-title":"J Neurointerv Surg."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"533","DOI":"10.3174\/ajnr.A5976","article-title":"Predictors and clinical impact of delayed stent thrombosis after Thrombectomy for acute stroke with tandem lesions","volume":"40","author":"Pop","year":"2019","journal-title":"AJNR Am J Neuroradiol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1136\/jnis-2023-020204","article-title":"Antithrombotic regimen in emergent carotid stenting for acute ischemic stroke due to tandem occlusion: a meta-analysis of aggregate data","volume":"16","author":"Diana","year":"2024","journal-title":"J Neurointervent Surg"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1007\/s12975-023-01214-9","article-title":"Safety outcomes of antiplatelet therapy during endovascular treatment of tandem lesions in acute ischemic stroke patients","author":"Farooqui","year":"2023","journal-title":"Transl Stroke Res"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"2522","DOI":"10.1161\/STROKEAHA.123.042966","article-title":"Safety outcomes of mechanical thrombectomy versus combined thrombectomy and intravenous thrombolysis in tandem lesions","volume":"54","author":"Rodriguez-Calienes","year":"2023","journal-title":"Stroke"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1136\/neurintsurg-2020-017202","article-title":"Endovascular therapy with or without intravenous thrombolysis in acute stroke with tandem occlusion","volume":"14","author":"Anadani","year":"2022","journal-title":"J Neurointerv Surg"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1177\/23969873221146383","article-title":"Safety and efficacy of tirofiban in acute ischemic stroke due to tandem lesions undergoing mechanical thrombectomy: a multicenter randomized clinical trial (ATILA) protocol","volume":"8","author":"Medina-Rodriguez","year":"2023","journal-title":"Eur Stroke J"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"973095","DOI":"10.3389\/fneur.2022.973095","article-title":"Endovascular treatment for ischemic stroke with the drip-and-ship model-insights from the German stroke registry","volume":"13","author":"Schaefer","year":"2022","journal-title":"Front Neurol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"2981","DOI":"10.1161\/STROKEAHA.115.010049","article-title":"The Heidelberg bleeding classification: classification of bleeding events after ischemic stroke and reperfusion therapy","volume":"46","author":"von Kummer","year":"2015","journal-title":"Stroke"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"2650","DOI":"10.1161\/STROKEAHA.113.001972","article-title":"Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement","author":"Zaidat","year":"2013","journal-title":"Stroke"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"e022335","DOI":"10.1161\/JAHA.121.022335","article-title":"Acute carotid artery stenting versus balloon angioplasty for tandem occlusions: a systematic review and Meta-analysis","volume":"11","author":"Zevallos","year":"2022","journal-title":"J Am Heart Assoc"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1278","DOI":"10.21037\/atm-2020-cass-17","article-title":"Treatment of the extracranial carotid artery in tandem lesions during endovascular treatment of acute ischemic stroke: a systematic review and meta-analysis","volume":"8","author":"Hellegering","year":"2020","journal-title":"Ann Transl Med"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1290","DOI":"10.1016\/j.jcin.2018.05.036","article-title":"Carotid stenting with antithrombotic agents and intracranial thrombectomy leads to the highest recanalization rate in patients with acute stroke with tandem lesions","volume":"11","author":"Papanagiotou","year":"2018","journal-title":"JACC Cardiovasc Interv"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e388","DOI":"10.1136\/jnis-2022-019875","article-title":"Comparison of three antithrombotic strategies for emergent carotid stenting during stroke thrombectomy: a multicenter study","volume":"15","author":"Pop","year":"2023","journal-title":"J Neurointerv Surg"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e230736","DOI":"10.1001\/jamanetworkopen.2023.0736","article-title":"Functional and safety outcomes of carotid artery stenting and mechanical thrombectomy for large vessel occlusion ischemic stroke with tandem lesions","volume":"6","author":"Farooqui","year":"2023","journal-title":"JAMA Netw Open"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1007\/s00270-023-03649-x","article-title":"Predictors of good clinical outcome after endovascular treatment for acute ischemic stroke due to tandem lesion in anterior circulation: results from the ASCENT study","volume":"47","author":"Havlicek","year":"2024","journal-title":"Cardiovasc Intervent Radiol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e14508","DOI":"10.1016\/j.heliyon.2023.e14508","article-title":"Outcome and risk of hemorrhage in patients with tandem lesions after endovascular treatment: a propensity score-matched case-control study","author":"Sepp","year":"2023","journal-title":"Heliyon"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"206","DOI":"10.3389\/fneur.2019.00206","article-title":"Impact of emergent cervical carotid stenting in tandem occlusion strokes treated by thrombectomy: a review of the TITAN collaboration","volume":"10","author":"Zhu","year":"2019","journal-title":"Front Neurol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1115","DOI":"10.1111\/ene.13633","article-title":"Impact of intravenous thrombolysis and emergent carotid stenting on reperfusion and clinical outcomes in patients with acute stroke with tandem lesion treated with thrombectomy: a collaborative pooled analysis","volume":"25","author":"Gory","year":"2018","journal-title":"Eur J Neurol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1186\/s42466-022-00207-7","article-title":"Antithrombotic treatment and outcome after endovascular treatment and acute carotid artery stenting in stroke patients with atrial fibrillation","volume":"4","author":"Weller","year":"2022","journal-title":"Neurol Res Pract"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13082315","article-title":"Age and stroke serverity matter most for clinical outcome in acute arteriosclerotic tandem lesions","volume":"13","author":"Huber","year":"2024","journal-title":"J Clin Med"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1554691\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T07:43:48Z","timestamp":1743579828000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1554691\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,2]]},"references-count":23,"alternative-id":["10.3389\/fneur.2025.1554691"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2025.1554691","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,2]]},"article-number":"1554691"}}