title: Endovascular Treatment of Tandem Common Carotid Artery Origin and Distal Intracranial Occlusion in Acute Ischemic Stroke.
abstract: BACKGROUND
  Tandem occlusion resulting in acute ischemic stroke is associated with high morbidity and mortality and a poor response to thrombolytic therapy. The use of endovascular strategies for tandem stroke cases results in an improved outcome for this subgroup of patients. We present 2 cases with a pattern of tandem occlusion consisting of proximal obstruction at the origin of the common carotid artery (CCA) with concomitant intracranial occlusion treated by endovascular techniques.
  
  
  METHODS
  The 2 patients presented each with occlusion at the left CCA origin and ipsilateral intracranial vessel (left middle cerebral artery and carotid terminus, respectively). A transfemoral anterograde approach was used to deliver a balloon-mounted stent across the proximal CCA origin occlusion to gain access to the distal cerebral vasculature. Subsequently, a stent retriever assisted mechanical aspiration thrombectomy was used to revascularize the intracranial occlusion.
  
  
  RESULTS
  Complete revascularization with Thrombolysis in Cerebral Infarction scores of 2b and improvement in neurologic deficits occurred in both cases. Good clinical outcome was achieved for both patients at 3-month follow-up.
  
  
  CONCLUSIONS
  An anterograde transfemoral approach should be considered in cases of tandem occlusion of the proximal CCA and middle cerebral artery.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Weiner
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Rafey
authors.initials: R
authors.lastname: Feroze
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Panczykowski
authors.affiliation: Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Amin
authors.initials: A
authors.lastname: Aghaebrahim
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: William
authors.initials: W
authors.lastname: Ares
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Nitin
authors.initials: N
authors.lastname: Agarwal
authors.affiliation: Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: John
authors.initials: J
authors.lastname: Enis
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Xiao
authors.initials: X
authors.lastname: Zhu
authors.affiliation: Barrow Neurological Institute, Phoenix, Arizona, USA. Electronic address: andrew.ducruet@barrowbrainandspine.com.
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Ducruet
mesh_terms: D021721:Balloon Occlusion / Q000379:methods; D016893:Carotid Stenosis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D002548:Cerebral Revascularization / Q000379:methods*; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D061185:Mechanical Thrombolysis / Q000379:methods*; D008875:Middle Aged; D020521:Stroke; D016896:Treatment Outcome
keywords: Acute ischemic stroke; Endovascular; Tandem; Thrombectomy