Objective To explore the feasibility and safety of carotid artery stenting during the procedure of emergency endovascular treatment in patients with carotid artery tandem lesions, and to analyze the effect of emergency carotid artery stenting on prognosis.Methods A total of 131 consecutive patients with carotid artery tandem lesions, who met the inclusion and exclusion criteria and underwent emergency endovascular treatment within 24 h of the onset in our division from May 2015 to Apr. 2021, were retrospectively included. They were divided into stenting group (93 cases) and non-stenting group (38 cases) according to whether undergoing carotid artery stenting during the procedure of emergency endovascular treatment. The baseline data, good prognosis (modified Rankin scale score ≤ 2) rate and mortality 90 d after operation, acute reocclusion rate and incidence of symptomatic intracranial hemorrhage (sICH) were compared between the 2 groups. According to the prognosis 90 d after operation, the patients were divided into good prognosis group (67 cases) and poor prognosis group (64 cases). The influencing factors of prognosis 90 d after operation were analyzed by univariate analysis, and the independent influencing factors of good prognosis were determined by multivariate logistic regression analysis.Results Compared with the non-stenting group, the patients in the stenting group were older, with higher proportion of diabetes mellitus, had a lower National Institutes of Health stroke scale (NIHSS) score on admission and a higher rate of good prognosis 90 d after operation, showing significant differences (all P < 0.05); and there were no significant differences in mortality 90 d after operation, incidence of sICH after operation or reocclusion rate (all P>0.05). Compared with the poor prognosis group, the patients in the good prognosis group were younger, had a lower NIHSS score on admission, fewer hyperdense area on C-arm computed tomography (CT) after operation, lower incidence rates of intracranial hemorrhage and sICH and a higher stenting rate, showing significant differences (all P < 0.05). Multivariate logistic regression analysis showed that younger age (odds ratio[OR]=0.931, 95% confidence interval[CI] 0.886-0.979, P=0.005), no sICH (OR=0.069, 95% 0.008-0.628, P=0.018) and no postoperative hyperdense area on C-arm CT (OR=0.187, 95% CI 0.060-0.589, P=0.004) were independent factors in predicting good prognosis of patients with carotid artery tandem lesions after emergency endovascular treatment, and no stenting was an independent factor in predicting poor prognosis (OR=4.583, 95% CI 1.476-14.228, P=0.008).Conclusion Carotid artery stenting during the procedure of emergency endovascular treatment is safe and feasible in patients with carotid artery tandem lesions. Emergency carotid artery stenting is an independent factor in predicting good prognosis.