Related Experiment Video
Updated: Jul 21, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Technical note on endovascular treatment of concomitant carotid occlusion in large vessel occlusion stroke: The
Christian N Ramsey1, Charles B Newman1, Michael R Jones1
1Baptist Health Lexington, Lexington, KY, USA.
Insights
The novel single-cross technique safely and effectively treats tandem carotid and intracranial occlusive lesions during emergent large vessel occlusion stroke, reducing procedure time and improving patient outcomes.
Area of Science:
- Endovascular therapy
- Neurointerventional procedures
- Cerebrovascular disease
Background:
- Emergent large vessel occlusion (ELVO) stroke often involves underlying carotid occlusive disease, complicating endovascular treatment.
- Severe carotid occlusive disease accounts for a significant percentage of ischemic strokes and ELVO cases.
- Current treatment strategies necessitate separate procedures for cervical and intracranial occlusions.
Observation:
- A novel "single-cross technique" was developed to address tandem internal carotid artery (ICA) origin and intracranial occlusive lesions.
- This technique leverages the stent retriever guidewire during mechanical thrombectomy to simultaneously address cervical carotid disease.
- Twenty-three consecutive patients were treated using this innovative endovascular approach.
Findings:
- The single-cross technique achieved an average procedure time of 52 minutes for revascularizing both carotid and intracranial lesions.
- A symptomatic intracranial hemorrhage rate of 9% was observed.
- Seventy-four percent of patients demonstrated favorable clinical outcomes with a modified Rankin Scale (mRS) score of 0-2 at 30 and 90 days.
Implications:
- The single-cross technique offers a potentially faster and more efficient approach to treating complex ELVO cases with tandem occlusions.
- This method may improve revascularization rates and clinical outcomes in patients with severe carotid occlusive disease and ELVO.
- Further research and validation are warranted to establish this technique as a standard of care.
Background:
Emergent large vessel occlusive (ELVO) stroke secondary to underlying carotid occlusive disease is frequently encountered in endovascular ischemic stroke therapy and trials. Up to 29% of all cerebral vascular accidents are attributed to severe carotid occlusive disease, and recent interventional trials have demonstrated this occurrence in 18.6-32.2% of ELVO stroke. We present a novel technique using the stent retriever guide wire to expedite angioplasty and/or stent placement for associated carotid occlusive disease during mechanical thrombectomy of ELVO stroke. This technique utilizes the "waiting time" during stent retriever integration within the thrombus as an opportunity to initiate revascularization of the cervical carotid, using the deployed stent retriever guidewire as an ad hoc rapid exchange wire while the stentriever serves as a potential surrogate distal embolic protection device. We present 23 cases using this novel endovascular approach, which we have called the single-cross technique, as the cervical lesion is only traversed once during therapy.
Methods:
A case series of 23 consecutive patients who underwent a novel endovascular technique for treating tandem ICA origin and intracranial occlusive lesions is presented. Endpoints measured were time to re-perfusion, rates of intracranial hemorrhage and clinical outcomes (mRS at 30 and 90 days).
Results:
Average procedure time for revascularizing both the carotid and intracranial lesions was 52 min. A symptomatic ICH rate of 9% was observed. Seventy-four percent of patients had an mRS of 0-2 at follow-up.
Conclusions:
The single-cross technique appears to be a safe and effective option for treating tandem occlusive lesions in the setting of ELVO.
