Acute carotid artery stenting for tandem occlusion leads to better functional outcomes and reperfusion rates than balloon angioplasty, a new analysis shows.

And a retrograde approach — performing mechanical thrombectomy before rather than after cervical recanalisation — appears to be most effective, according to clinicians from the University of Iowa Hospitals and Clinics in the US.

In a systematic review of 34 studies — nine of which qualified for meta-analysis — the team compared the efficacy and safety of acute carotid artery stenting with balloon angioplasty alone for treating the cervical lesion in 3000 patients with tandem occlusions.

They also assessed the association of the technique approaches (retrograde versus anterograde) with the functional and safety outcomes and use of thrombolysis.