One-stage Anterograde Revascularization for Tandem Lesion Developed for Acute Cerebral Ischemic Stroke

An optimal treatment strategy has not been established for acute ischemic stroke (AIS) caused by intracranial artery occlusion associated with severe stenosis of the cervical internal carotid artery (ICA), also known as a tandem lesion. Herein, we describe our experience with two cases of tandem lesions, including device selection and treatment strategy. A tandem lesion was observed on emergency angiography. In the subsequent revascularization procedure, carotid artery stenting (CAS) was first performed for the cervical lesion, after which the guiding catheter was passed through the stent and placed in the ICA. Both outcomes received a score of 1 on the modified Rankin Scale (mRS), which is considered to be good. The time to reperfusion was delayed by about 15 minutes due to the CAS procedure; however, the guiding catheter was able to pass the cervical lesion relatively safely. Consecutive and anterograde treatments for tandem lesions were effective in AIS.