Semin intervent Radiol 2020; 37(02): 207-213
DOI: 10.1055/s-0040-1709207
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Treatment Strategies for Tandem Occlusions in Acute Ischemic Stroke

Joseph J. Gemmete
1  Department of Radiology, Michigan Medicine, Ann Arbor, Michigan
2  Department of Neurosurgery, Michigan Medicine, Ann Arbor, Michigan
,
Zachary Wilseck
1  Department of Radiology, Michigan Medicine, Ann Arbor, Michigan
,
Aditya S. Pandey
1  Department of Radiology, Michigan Medicine, Ann Arbor, Michigan
2  Department of Neurosurgery, Michigan Medicine, Ann Arbor, Michigan
,
Neeraj Chaudhary
1  Department of Radiology, Michigan Medicine, Ann Arbor, Michigan
2  Department of Neurosurgery, Michigan Medicine, Ann Arbor, Michigan
› Author Affiliations
Further Information

Publication History

Publication Date:
14 May 2020 (online)

Abstract

There is no consensus for the treatment of a tandem occlusion (TO) in a patient presenting with an acute ischemic stroke. In this review article, we will focus on the controversial treatment strategies for TOs. First, we will discuss treatment options including retrograde, antegrade, and delayed approaches. Second, the role of carotid stent placement versus balloon angioplasty for the extracranial occlusion will be presented. Third, anticoagulation and antiplatelet regimens for the treatment TOs published in the literature will be reviewed. Finally, we will discuss whether there is a role for coil occlusion of the cervical carotid artery or whether staged carotid revascularization days after mechanical thrombectomy of the intracranial occlusion maybe appropriate. The optimal treatment strategy of TO has not been established and further larger trials need to be performed to answer the question.