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Balloon-Expandable Stenting as a Bridging Therapy in Patients With Acute Stroke and Tandem Occlusions

Noelia Rodríguez-Villatoro1,2, David Rodríguez-Luna1, Marian Muchada1

  • 1Unitat d'Ictus Hospital Universitari Vall d'Hebron Barcelona Spain.

Stroke (Hoboken, N.J.)
|January 26, 2026
PubMed

Insights

Bridging therapy using balloon-expandable (BX) stents followed by self-expanding (SX) stents for extracranial internal carotid artery (ICA) lesions in acute ischemic stroke reduced hemorrhagic complications. This approach maintained stent patency without increasing restenosis or reocclusion rates.

Area of Science:

  • Neurology
  • Vascular Surgery
  • Interventional Radiology

Background:

  • Stenting extracranial internal carotid artery (ICA) lesions in acute ischemic stroke with tandem lesions presents technical challenges.
  • The safety of stenting is debated due to the need for dual-antiplatelet therapy.
  • Optimal stenting devices, timing, and antiplatelet strategies for these cases remain unclear.

Purpose of the Study:

  • To compare the safety and efficacy of self-expanding (SX) versus balloon-expandable (BX) carotid stents in treating extracranial ICA lesions in patients with acute ischemic stroke and tandem occlusions.
  • To evaluate the rates of symptomatic intracranial hemorrhage and extracranial ICA patency between the two stenting groups.

Main Methods:

  • A retrospective study included 112 patients with acute ischemic stroke and tandem lesions treated between April 2016 and April 2021.
  • Patients received either conventional self-expanding (SX) stents or balloon-expandable (BX) stents, with BX stents being restented with SX stents in the subacute phase.
  • Primary outcomes assessed were extracranial ICA patency and symptomatic intracranial hemorrhage.

Main Results:

  • Dual-antiplatelet therapy was more common in the SX group (89.7%) than the BX group (27.4%).
  • The BX stent group had a significantly lower rate of symptomatic intracranial hemorrhage (4.1%) compared to the SX stent group (17.9%).
  • No significant differences in high-grade restenosis or reocclusion were observed between the groups at 24 hours post-procedure.

Conclusions:

  • Bridging therapy with BX stents and less aggressive antiplatelet therapy, followed by definitive SX stenting, is a viable strategy for treating extracranial ICA lesions in acute ischemic stroke with tandem occlusions.
  • This approach resulted in a lower rate of symptomatic hemorrhagic transformation without compromising stent patency.
  • The findings suggest a potentially safer alternative for managing these complex cerebrovascular cases.
Abstract

Keywords:
antiplatelet therapyendovascular thrombectomyinternal carotid arterystentstroke

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