ESOC 2026 | Updates on the management of tandem occlusions in AIS: the CASES trial and tirofiban

We had some new studies being discussed and presented at ESOC on this topic. It is very interesting. We had CASES and together with also another observational study presented last year and this was more in favor but this is a randomized study but this was more in favor of doing an acute carotid stenting instead of a deferred treatment since it was non-inferior. And of course, oftentimes it may be easier to do it immediately. And there may be also a benefit in terms of recurrent events early on after a thrombectomy if there’s no protection, so no stenting of the carotid stenosis. So overall, this comes again to the conclusion that we were already building before based on observational evidence that it is safe to do acute stenting in most patients and also that it may be even protective of some early events and it’s at least non-inferior in this study. Also, we do have some new evidence on the use of tirofiban in these patients with acute stenting. This type of agent has been used for a long time in patients with acute stenting. But it is good that we have now better evidence of the benefit of this approach and the safety as well. So it is definitely an important topic for research because it is a very severe disease and the management may be difficult. And there was a lot of uncertainty on the medical management, on the interventional management. And now we are building an interesting body of evidence to support our decisions in this very severe and difficult to manage population of ischemic stroke associated with tandem occlusion. So large vessel occlusion and carotid severe stenosis or occlusion simultaneously ipsilateral.

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