Scoring Balloon Angioplasty Maintains Parent Artery Patency in Tandem Lesion Stroke until Safe Stent Placement Is...

To evaluate scoring balloon angioplasty of proximal carotid tandem lesions (rather than immediate carotid stent placement) after endovascular thrombectomy of intracranial large-vessel occlusion.

Between January 2021 and August 2023, all patients (33 patients; mean age 72.8 years; 88% male) in a single center who presented with tandem carotid lesions after endovascular thrombectomy and were treated using a scoring balloon for angioplasty of the proximal lesion were reviewed.

From a total of 376 EVT patients, 33 had tandem lesions and underwent parent artery scoring balloon angioplasty. After angioplasty, 6 patients required immediate carotid artery stent placement, 4 due to underlying dissections and 2 due to balloon failures; no procedural complications were reported. Among the 30 patients with follow-up imaging, 77% had patent arteries on follow-up imaging, 10% had complete reocclusion, and 13% had partial restenosis, although only 2 patients clinically deteriorated. At 90 days, 70% of the patients had favorable outcomes (modified Rankin Scale score of ≤3), with better results observed in those who did not require immediate carotid artery stenting, and no cases of symptomatic intracranial hemorrhage occurred.

Scoring balloon angioplasty is a simple, safe, and effective technical modification that may improve the safety of treatment for tandem lesions by decreasing the need for upfront carotid stent placement and anti-platelet therapy thereby possibly reducing the risk of symptomatic intracranial hemorrhage.