{
  "abstract": "Background Treatment options for cervical internal carotid artery (c-ICA) occlusion in tandem occlusions (TOs) include emergent carotid artery stenting (eCAS) and angioplasty. We attempted to determine the impact of c-ICA reocclusion on the risk of recurrent ischemic stroke (IS) and stroke-related death, as well as functional independence.Methods Patients with TOs undergoing endovascular thrombectomy (EVT) from April 2016 to October 2024 were included. The primary outcome was the 90-day composite of recurrent IS and stroke-related death. Secondary outcomes included the rate of 90-day functional independence (modified Rankin Scale (mRS) 0–2) and mortality. We used binary logistic regression to explore the association between c-ICA reocclusion and the outcomes and to identify predictors of c-ICA reocclusion or future revascularization.Results We included 163 patients, 85.9% with successful recanalization. Angioplasty and eCAS were performed in 70% and 19%, respectively. c-ICA reocclusion occurred in 22% at a median of 3.5 (0–41.7) days. c-ICA reocclusion increased the odds of recurrent IS or stroke-related death (adjusted OR (aOR) 2.90, 95% CI 1.07 to 8.30, P=0.036) and was associated with lower rates of independence (aOR 0.18, 95% CI 0.05 to 0.58, P=0.004). Among patients who did not undergo eCAS, c-ICA angioplasty (aHR 0.28, 95% CI 0.09 to 0.86, P=0.026) and residual stenosis (aHR 1.04, 95% CI 1.02 to 1.07, P<0.001) were independent predictors of reocclusion or future revascularization.Conclusion Maintaining c-ICA patency after EVT might be essential due to the association of reocclusion with recurrent IS, stroke-related death, and worse functional outcomes. Residual c-ICA stenosis and angioplasty are valuable predictors of c-ICA patency that can guide management during EVT.",
  "authors": [
    {
      "affiliations": [
        "Department of Clinical Neurological Sciences, University of Western Ontario Schulich School of Medicine & Dentistry, London, Ontario, Canada"
      ],
      "name": "Alonso Alvarado-Bolanos"
    },
    {
      "affiliations": [
        "Department of Medical Imaging, University of Western Ontario Schulich School of Medicine & Dentistry, London, Ontario, Canada",
        "Department of Medicine, Faculty of Medicine and Health Sciences An-Najah National University, Nablus, Palestine"
      ],
      "name": "Mosab Maree"
    },
    {
      "affiliations": [
        "Department of Clinical Neurological Sciences, University of Western Ontario Schulich School of Medicine & Dentistry, London, Ontario, Canada",
        "Department of Surgery, The University of Adelaide, Adelaide, South Australia, Australia"
      ],
      "name": "Annika Mascarenhas"
    },
    {
      "affiliations": [
        "Department of Medical Imaging, University of Western Ontario Schulich School of Medicine & Dentistry, London, Ontario, Canada"
      ],
      "name": "Sachin K Pandey"
    },
    {
      "affiliations": [
        "Department of Medical Imaging, University of Western Ontario Schulich School of Medicine & Dentistry, London, Ontario, Canada",
        "Department of Medical Imaging, Northern Ontario School of Medicine University, Sudbury, Ontario, Canada"
      ],
      "name": "Ruba Kiwan"
    },
    {
      "affiliations": [
        "Department of Clinical Neurological Sciences, University of Western Ontario Schulich School of Medicine & Dentistry, London, Ontario, Canada"
      ],
      "name": "Victor Yang"
    },
    {
      "affiliations": [
        "Department of Clinical Neurological Sciences, University of Western Ontario Schulich School of Medicine & Dentistry, London, Ontario, Canada",
        "Department of Medical Imaging, University of Western Ontario Schulich School of Medicine & Dentistry, London, Ontario, Canada"
      ],
      "name": "Michael Mayich"
    },
    {
      "affiliations": [
        "Department of Medical Imaging, University of Western Ontario Schulich School of Medicine & Dentistry, London, Ontario, Canada"
      ],
      "name": "Manas Sharma"
    },
    {
      "affiliations": [
        "Department of Clinical Neurological Sciences, University of Western Ontario Schulich School of Medicine & Dentistry, London, Ontario, Canada"
      ],
      "name": "Melfort Boulton"
    },
    {
      "affiliations": [
        "Department of Clinical Neurological Sciences, University of Western Ontario Schulich School of Medicine & Dentistry, London, Ontario, Canada"
      ],
      "name": "Jennifer Mandzia"
    },
    {
      "affiliations": [
        "Department of Clinical Neurological Sciences, University of Western Ontario Schulich School of Medicine & Dentistry, London, Ontario, Canada",
        "Department of Epidemiology and Biostatistics, Univeristy of Western Ontario Schulich School of Medicine & Dentistry, London, Ontario, Canada"
      ],
      "name": "Sebastian Fridman"
    }
  ],
  "title": "Relevance of cervical internal carotid artery patency after thrombectomy in tandem occlusion. Are we missing an opportunity to revascularize?",
  "uid": "482f5016-f993-5bc6-9719-902d256de799"
}