The Tandem Occlusion

Depending on the population studied, large vessel anterior circulation acute ischemic strokes with concomitant extracranial internal carotid artery tandem occlusions constitute 10–25% of cases presenting for consideration for endovascular therapy. Leaving them untreated or treating them with IV-tPA only portends to poor clinical outcomes for this subset of acute stroke patients. As for intracranial large vessel occlusions, the best outcomes are achieved through endovascular therapies that revascularize the occluded vessels in a timely manner. Using case examples, various treatment strategies for addressing tandems occlusions are discussed. The pros and cons of these treatment options are detailed to inform and assist the interventionalist in determining the best course of action when confronted with this clinical scenario.