Related Experiment Video
Updated: May 22, 2026

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Management of tandem occlusion stroke with endovascular therapy
Haitham Dababneh1, Waldo R Guerrero, Anna Khanna
1Department of Neurology, University of Florida, Gainesville, Florida 32610-0236, USA. dababneh@neurology.ufl.edu
Object:
Approximately 25% of patients with middle cerebral artery (MCA) occlusion will have a concomitant internal carotid artery (ICA) occlusion, and 50% of patients with an ICA occlusion will have a proximal MCA occlusion. Cervical ICA occlusion with MCA embolic occlusion is associated with a low rate of recanalization and poor outcome after intravenous thrombolysis. The authors report their experience with acute ischemic stroke patients who suffered tandem ICA/MCA (TIM) occlusions and underwent intravenous thrombolysis followed by extracranial ICA angioplasty and intracranial MCA mechanical thrombectomy.
Methods:
In a retrospective analysis of their stroke database (2008-2011), the authors identified 2 patients with TIM occlusion treated with intravenous thrombolysis followed by extracranial ICA angioplasty and intracranial mechanical thrombectomy. They examined early neurological improvement defined by a greater than 10-point reduction of National Institutes of Health Stroke Scale (NIHSS) score and an improved modified Rankin Scale (mRS) score at 60 days. Successful recanalization based on thrombolysis in cerebral infarction (TICI) score of 2 or 3 was also evaluated.
Results:
In both patients a TICI score of 2b or 3 was achieved, signifying successful recanalization. In addition, both patients had a reduction in the NIHSS score by greater than 10 points and an mRS score of 0 at 60 days.
Conclusions:
Tandem occlusions of the cervical ICA and MCA may be successfully treated using the multimodality approach of intravenous thrombolysis followed by extracranial ICA angioplasty and intracranial mechanical thrombectomy.
Related Concept Videos
Venous Thrombosis III: Interprofessional Care
Hemorrhagic Stroke ll: Pathophysiology
Mitral Stenosis III: Medical Management
Ischemic Stroke l: Introduction
Aneurysm IV: Nursing Management
Aneurysm III: Interprofessional Care
