Tandem occlusion is defined by an acute ischemic stroke (AIS) with concomitant
steno-occlusive disease of the extra cranial carotid artery and concerned about 10% of AIS
patients. Whereas endovascular treatment has shown its efficiency in AIS by large vessel
occlusion (LVO), to date, there is no consensus on the endovascular management of the extra
cranial carotid artery in tandem occlusion. Only few of them were included in previous
randomized trials who evaluated mechanical thrombectomy and were often listed in the
non-inclusion criteria. Therapeutic management of this population was not specifically
addressed in recent trials. Endovascular management can be complex with the need of acute
stenting of the extra cranial carotid lesion along with the potential need of antithrombotic
therapy initiation, the benefit and the safety of stenting of the cervical lesion in acute
phase of AIS have shown encouraging results but however remains to be assessed. The TITAN
(Thrombectomy In TANdem lesion) trial aims to demonstrate the superiority of the combined use
of intracranial thrombectomy and extracranial carotid stenting compared to intracranial
thrombectomy alone on the complete reperfusion rate in patients with acute ischemic stroke
due to tandem lesion.