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Tandem Carotid Lesions in Acute Ischemic Stroke: Mechanisms, Therapeutic Challenges, and Future Directions

A Y Poppe1,2, G Jacquin3,2, D Roy4

  • 1From the Departments of Medicine (Neurology) (A.Y.P., G.J., C.S.) alexandre.poppe.chum@ssss.gouv.qc.ca.

AJNR. American Journal of Neuroradiology
|June 6, 2020
PubMed

Insights

Tandem lesions, a combination of cervical internal carotid artery and intracranial occlusions, affect 15% of stroke patients. Optimal management during endovascular thrombectomy remains debated, impacting patient outcomes.

Area of Science:

  • Neurology
  • Interventional Neuroradiology
  • Vascular Surgery

Background:

  • Tandem lesions (cervical internal carotid artery stenosis/occlusion + intracranial occlusion) occur in ~15% of acute ischemic stroke patients undergoing endovascular thrombectomy.
  • Patients with tandem lesions experience poorer outcomes compared to those with isolated intracranial occlusions.
  • Optimal management of the cervical component during endovascular thrombectomy is controversial.

Purpose of the Study:

  • To review the current management strategies for tandem lesions in anterior circulation acute ischemic stroke.
  • To highlight the controversy surrounding the optimal approach: acute stent placement versus thrombectomy alone.
  • To emphasize the need for randomized trials to guide clinical decision-making and improve patient care.

Main Methods:

  • Review of current clinical practice and existing literature regarding tandem lesion management.
  • Discussion of treatment options including acute stent placement and standalone thrombectomy.
  • Identification of factors influencing treatment decisions (clinical, anatomical, technical).

Main Results:

  • Tandem lesions present a complex management challenge in acute ischemic stroke.
  • Current practice varies, with no universally adopted optimal strategy.
  • Lack of definitive comparative data from randomized trials hinders evidence-based recommendations.

Conclusions:

  • Management of tandem lesions during endovascular thrombectomy requires careful consideration of multiple factors.
  • Further randomized controlled trials are essential to compare acute stent placement versus thrombectomy alone.
  • Evidence-based guidelines are needed to optimize outcomes for stroke patients with tandem lesions.

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