Objective To evaluate the efficacy and safety of mechanical thrombectomy of intracranial artery combined with carotid stent implantation in the treatment of acute ischemic stroke caused by tandem lesions of internal carotid artery.Methods A total of 55 patients with acute ischemic stroke caused by tandem lesions of internal carotid artery treated in Department of Neurosurgery of Liaocheng People's Hospital (Brain Hospital) from Jan. 2019 to Dec. 2020 were retrospectively included. Among them, 43 patients (distal-to-proximal group) were treated with mechanical thrombectomy for the occluded lesion of intracranial artery, followed by stent implantation for the severe stenotic/occluded lesions of initial internal carotid artery, and 12 patients (proximal-to-distal group) were treated with stent implantation for the severe stenotic/occluded lesions of initial internal carotid artery, followed by mechanical thrombectomy for the occluded lesion of intracranial artery. Onset-to-puncture time, National Institutes of Health stroke scale (NIHSS) scores on admission, and 24 h and 7 d after operation, the success rate of 1-time thrombectomy during operation, puncture-to-recanalization time, rate of successful recanalization immediately after operation (modified thrombolysis in cerebral infarction grade ≥ 2b), incidence of postoperative symptomatic intracranial hemorrhage, and good prognosis (modified Rankin scale score ≤ 2) rate and mortality 90 d after operation were compared between the 2 groups.Results All patients successfully received mechanical thrombectomy of intracranial artery and stent implantation of initial internal carotid artery. The success rate of 1-time thrombectomy in the distal-to-proximal group was significantly higher than that in the proximal-to-distal group (67.4%[29/43] vs 33.3%[4/12], P < 0.05), and the puncture-to-recanalization time was significantly shorter than that in the proximal-to-distal group ([68.77±17.65] min vs[100.08±38.38] min, P < 0.05). There were no significant differences in the onset-to-puncture time, NIHSS scores on admission, 24 h and 7 d after operation, successful recanalization rate immediately after operation, incidence of postoperative symptomatic intracranial hemorrhage, or good prognosis rate and mortality 90 d after operation between the 2 groups (all P>0.05).Conclusion Mechanical thrombectomy of intracranial artery combined with carotid stent implantation is safe and effective in the treatment of acute ischemic stroke caused by tandem lesions of internal carotid artery. The distal-to-proximal strategy has a higher success rate of 1-time thrombectomy than the proximal-to-distal strategy, and can achieve successful recanalization much faster.