Endovascular Treatment of Tandem Common Carotid Artery Origin and Distal Intracranial Occlusion in Acute Ischemic Stroke

Authors

Gregory M. Weiner, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Rafey Feroze, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
David M. Panczykowski, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Amin Aghaebrahim, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
William Ares, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Nitin Agarwal, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
John Enis, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Xiao Zhu, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Andrew F. Ducruet, Barrow Neurological Institute, Phoenix, Arizona, USA. Electronic address: andrew.ducruet@barrowbrainandspine.com.Follow

Document Type

Article

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.

Keywords

Acute ischemic stroke, Endovascular, Tandem, Thrombectomy

Medical Subject Headings

Balloon Occlusion (methods); Carotid Stenosis (complications, diagnosis, therapy); Cerebral Revascularization (methods); Cerebrovascular Disorders (complications, diagnosis, therapy); Combined Modality Therapy (methods); Endovascular Procedures (methods); Female; Humans; Male; Mechanical Thrombolysis (methods); Middle Aged; Stroke; Treatment Outcome

Publication Date

1-1-2017

Publication Title

World neurosurgery

E-ISSN

1878-8769

Volume

97

First Page

360

Last Page

365

PubMed ID

27751921

Digital Object Identifier (DOI)

10.1016/j.wneu.2016.10.039

Recommended Citation

Weiner, Gregory M.; Feroze, Rafey; Panczykowski, David M.; Aghaebrahim, Amin; Ares, William; Agarwal, Nitin; Enis, John; Zhu, Xiao; and Ducruet, Andrew F., "Endovascular Treatment of Tandem Common Carotid Artery Origin and Distal Intracranial Occlusion in Acute Ischemic Stroke" (2017). Translational Neuroscience. 2090.
https://scholar.barrowneuro.org/neurobiology/2090