title: Combined use of stent angioplasty and mechanical thrombectomy for acute tandem internal carotid and middle cerebral artery occlusion.
abstract: OBJECTIVE
  Tandem internal carotid and middle cerebral artery occlusion carries a grave prognosis, with intravenous and intra-arterial thrombolytics having low efficacy. Currently, endovascular therapy is a promising means for treatment in which the proximal carotid lesion can be treated with angioplasty and stenting, whilst mechanical thrombectomy can be used for the treatment of the distal occlusion. Two approaches can be used - the antegrade (proximal-to-distal) approach or the retrograde (distal-to-proximal) approach, although there has not yet been any consensus on which is the better approach.
  
  
  METHODS
  We present two patients with tandem occlusions, one treated using the antegrade and one using the retrograde approach, with different revascularization outcomes, despite having similar functional outcome on follow-up.
  
  
  CONCLUSIONS
  The combined use of stent angioplasty and mechanical thrombectomy can be used to treat tandem occlusions, and with procedural modifications, the antegrade approach may more easily achieve technical success.
authors.affiliation: Department of Interventional Neurology, Beijing Tiantan Hospital, China China National Clinical Research Center for Neurological Diseases, China Center of Stroke, Beijing Institute for Brain Disorders, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Gao
authors.affiliation: Department of Medicine, Queen Elizabeth Hospital, Hong Kong.
authors.forename: WaiTing
authors.initials: W
authors.lastname: Joyce Lo
authors.affiliation: Department of Interventional Neurology, Beijing Tiantan Hospital, China China National Clinical Research Center for Neurological Diseases, China Center of Stroke, Beijing Institute for Brain Disorders, China.
authors.forename: Xuan
authors.initials: X
authors.lastname: Sun
authors.affiliation: Department of Interventional Neurology, Beijing Tiantan Hospital, China China National Clinical Research Center for Neurological Diseases, China Center of Stroke, Beijing Institute for Brain Disorders, China.
authors.forename: XiaoTong
authors.initials: X
authors.lastname: Xu
authors.affiliation: Department of Interventional Neurology, Beijing Tiantan Hospital, China China National Clinical Research Center for Neurological Diseases, China Center of Stroke, Beijing Institute for Brain Disorders, China zhongrongm@163.com.
authors.forename: ZhongRong
authors.initials: Z
authors.lastname: Miao
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000379:methods*; D002341:Carotid Artery Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015607:Stents; D017131:Thrombectomy / Q000379:methods*
keywords: Angioplasty; carotid artery; mechanical thrombectomy; stroke; tandem occlusion