Different etiologies of extracranial internal carotid artery steno-occlusive lesions (ECLs) in patients with acute ischemic stroke (AIS) and tandem occlusion (TO) have been pooled together in randomized trials. However, carotid atherosclerosis (CA) and carotid dissection (CD), the two most common ECL etiologies, are distinct nosological entities. The authors aimed to determine if ECL etiology has impacts on the endovascular management and outcome of patients with TO.

A multicenter, retrospective study of prospectively collected data was conducted. AIS patients were included who had TO due to internal CA or CD and ipsilateral M₁ middle cerebral artery occlusion and underwent endovascular treatment (EVT). Comparative analyses including demographic data, safety, successful recanalization rates, and clinical outcome were performed according to EVT and ECL etiology.

In total, 214 AIS patients with TOs were included (77.6% CA related, 22.4% CD related). Patients treated with a retrograde approach were more often functionally independent at 3 months than patients treated with an antegrade approach (OR 0.6, 95% CI 0.4–0.9). Patients with CD-related TOs achieved 90-day clinical independence more often than patients with CA-related TOs (OR 1.4, 95% CI 1.1–2.0). Emergency stenting use was associated with good 3-month clinical outcome only in patients with CA-related TOs (OR 1.4, 95% CI 1.1–2.1). Symptomatic intracranial hemorrhage (sICH) occurred in 10.7% of patients, without differences associated with ECL etiology.

ECL etiology impacts both EVT approach and clinical outcome in patients with TOs. Patients with CD-related TO achieved higher 3-month functional independence rates than patients with CA-related TOs. A retrograde approach can be desirable for both CA- and CD-related TOs, and emergency stenting is likely better justified in CA-related TOs.

急性缺血性卒中 (AIS) 和串联闭塞 (TO) 患者颅外颈内动脉狭窄闭塞病变 (ECL) 的不同病因已在随机试验中汇总。然而，颈动脉粥样硬化 (CA) 和颈动脉夹层 (CD) 是两种最常见的 ECL 病因，是不同的疾病分类实体。作者旨在确定 ECL 病因是否对 TO 患者的血管内治疗和结果产生影响。

对前瞻性收集的数据进行了多中心、回顾性研究。包括因内部 CA 或 CD 和同侧 M ₁大脑中动脉闭塞而患有 TO并接受血管内治疗 (EVT) 的AIS 患者。根据 EVT 和 ECL 病因进行比较分析，包括人口统计学数据、安全性、成功再通率和临床结果。

总共包括 214 名有 TO 的 AIS 患者（77.6% 与 CA 相关，22.4% 与 CD 相关）。与顺行方法治疗的患者相比，逆行方法治疗的患者在 3 个月时更常功能独立（OR 0.6，95% CI 0.4-0.9）。CD 相关 TO 患者比 CA 相关 TO 患者更常实现 90 天临床独立（OR 1.4，95% CI 1.1-2.0）。仅在 CA 相关 TO 患者中，紧急支架植入术与良好的 3 个月临床结果相关（OR 1.4，95% CI 1.1-2.1）。有症状的颅内出血 (sICH) 发生在 10.7% 的患者中，与 ECL 病因无关。

ECL 病因会影响 TO 患者的 EVT 方法和临床结果。CD 相关 TO 患者的 3 个月功能独立率高于 CA 相关 TO 患者。CA 和 CD 相关的 TOs 可能需要逆行方法，并且在 CA 相关的 TOs 中紧急支架植入术可能更合理。