Acute Ischemic Stroke Due to Common Carotid Ostial Disease with Tandem Intracranial Occlusions Treated with Thrombectomy and Staged Retrograde Stenting

Overview

Journal Interv Neurol

Date 2018 Nov 10

PMID 30410523

Citations 3

Authors

Krishna Amuluru

Fawaz Al-Mufti

Charles E Romero

Affiliations

Soon will be listed here.

Abstract

Background: Acute ischemic stroke due to tandem occlusive lesions of the anterior circulation involves an intracranial large vessel occlusion as well as a concurrent occlusion or high-grade stenosis of the proximal carotid system. The vast majority of proximal lesions in tandem occlusive cases involve the extracranial internal carotid artery, although the lesion can theoretically exist anywhere along the carotid artery pathway, including the common carotid ostium.

Summary: To the best of our knowledge, only 1 report describes common carotid artery ostial lesions in the setting of acute ischemic stroke due to tandem occlusions, in which the authors describe an anterograde treatment paradigm. We present the first 2 cases of acute ischemic stroke secondary to common carotid ostial disease with tandem intracranial occlusion, treated with intracranial thrombectomy followed by subsequent staged balloon-mounted stenting of the common carotid ostium. We review the pathophysiology of tandem occlusions, the controversy surrounding treatment techniques, and various approaches used in the treatment of ostial occlusive lesions.

Key Message: In certain situations where acute carotid stenting is not safe or technically possible, immediate intracranial thrombectomy with a subsequent staged balloon-mounted stenting of the ostial lesion may be a reasonable and safe option.

Citing Articles

The Dilator-Dotter technique can successfully treat tandem lesions of posterior circulation.

Han N, Ma L, Zhao L, Xu G, Jia Y, Wang H Medicine (Baltimore). 2024; 103(4):e37044.

PMID: 38277540 PMC: 10817093. DOI: 10.1097/MD.0000000000037044.

Ostial common carotid artery occlusion and balloon-mounted stenting: Implication of embolic protection device in tandem lesion.

Mizowaki T, Fujita A, Imura J, Nakahara M, Tanaka H, Takaishi Y Radiol Case Rep. 2021; 16(9):2783-2786.

PMID: 34367395 PMC: 8326589. DOI: 10.1016/j.radcr.2021.06.071.

The Dilator-Dotter Technique: A Modified Method of Rapid Internal Carotid Artery Revascularization in Acute Ischemic Stroke.

Amuluru K, Sahlein D, Al-Mufti F, Payner T, Kulwin C, DeNardo A AJNR Am J Neuroradiol. 2020; 41(10):1863-1868.

PMID: 32883663 PMC: 7661069. DOI: 10.3174/ajnr.A6733.

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