A retrospective analysis of pooled data from 18 centers examined 395 patients with AIS caused by tandem lesion of the anterior circulation who underwent mechanical thrombectomy (TITAN [Thrombectomy in Tandem Lesions]). mTICI grade 2b/3 was achieved in 76.7% of patients. At 90 days, 52.2% achieved an mRS score of 0 to 2, 13.8% had parenchymal hematoma, and 13.2% were dead.202 Multiple retrospective reports detail the technical success of mechanical thrombectomy for tandem occlusions but do not provide specifics on comparative approaches. No conclusions about the optimum treatment approach for patients with tandem occlusions are therefore possible. See Tables XVII and XLV in online Data Supplement 1. The safety and efficacy of IV glycoprotein IIb/IIIa inhibitors administered during endovascular stroke treatment are uncertain. IIb C-LD New recommendation. Uncertainty remains about the safety and efficacy of IV glycoprotein IIb/IIIa inhibitors, including abciximab, administered in the setting of endovascular stroke treatment. The published literature is limited primarily to case series and retrospective reviews of single-center databases and focuses largely on administration of IV glycoprotein IIb/IIIa inhibitors to prevent thrombus formation during emergent carotid and vertebrobasilar artery stenting and Further research is needed comprising multicenter analyses of endovascular stroke therapy necessitating adjunctive antiplatelet therapy for emergent angioplasty and stenting. See Table XXXIX in online Data Supplement 1. Use of salvage technical adjuncts, including intra-arterial fibrinolysis, may be reasonable to achieve mTICI grade 2b/3 angiographic results. IIb C-LD Recommendation reworded for clarity from 2015 Endovascular. COR unchanged. LOE amended to conform with ACC/AHA 2015 Recommendation Classification System. See Table XCV in online Data Supplement 1 for original wording. Intra-arterial fibrinolytic therapy played a limited role in the recent endovascular trials but was used as rescue therapy, not initial treatment. 