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Introduction While mechanical thrombectomy for eligible patients with large vessel occlusion has become standard of care, the role of acute carotid stenting in the setting of tandem occlusion remains unclear. We set out to assess the safety of acute carotid stenting during mechanical thrombectomy in the setting of tandem occlusion.Materials and Methods A single-center retrospective review of patients who underwent mechanical thrombectomy between January 1, 2021 and December 31, 2024 was performed. The rate of tandem occlusion, treatment strategy, complications, and outcomes were then analyzed. Categorical data were analyzed using Chi-squared test and logistic regression, and continuous data were analyzed with non-parametric methods including Mann-Whitney U test.Results Of 300 patients undergoing thrombectomy, 53 (17.7%) underwent carotid stenting for tandem occlusion. Baseline characteristics, including age, sex, NIHSS (16.2 vs 15.4, p=0.34), and 90-day mRS (3.19 vs 3.21, p=0.96), were similar between groups. Among stented patients, 42 (79.2%) received one stent and 11 (20.8%) required two; the most common device was the Boston Scientific carotid wall stent (7×40 mm). ICH occurred in 11 patients (20.8%), with one symptomatic case (1.9%). Asymptomatic ICH did not impact 90-day mRS (3.10 vs 3.22, p=0.87). ICH was more frequent with intra-operative GpIIb/IIIa inhibitors (26.5% vs 10.5%, p=0.23), though not independently significant on penalized regression. Higher NIHSS predicted hemorrhage on logistic regression analysis. The symptomatic ICH patient was mRS 3.Conclusions In our single-center review of acute carotid stenting during mechanical thrombectomy for tandem occlusions, stenting was associated with a low-rate of symptomatic ICH. Patients who experienced an asymptomatic ICH had similar 90-day outcomes based on mRS as those who did not undergo stenting. The use of intra-operative GPIIb/IIIa was also associated with a higher rate of ICH, though did not reach statistical significance. Based on our single-center experience, acute carotid stenting in the setting of tandem occlusion appears to be safe, though further large-scale trials are needed.Disclosures B. Newton: None. R. Buni: None. A. Persad: None. R. Whelan: None. S. Wasyliw: None. R. Cooley: None. B. Graham: None. M. Kelly: 2; C; Medtronic Inc, Penumbra Inc, Cerenovus Inc.. 4; C; Endostream Inc., Basecamp Vascular, Radical Medical, Custom Health. L. Ogieglo: None. S. Ahmed: None.