Management of acute tandem internal carotid artery and middle cerebral artery occlusions with endovascular multimodal reperfusion therapy

Objective To evaluate the safety and efficacy of multimodal reperfusion therapy (MMRT) for acute tandem internal carotid artery and middle cerebral artery (TIM)occlusions.Methods Six cases of TIM occlusions were analyzed retrospectively,including etiology,sites of tandem occlusion,compensation,location and size of infarcts,mechanical recanalization technique and its complications.Changes of National Institute of Health Stroke Scale (NIHSS) score and image findings between pre-and post-procedure were further compared.The modified Rankin scores (mRS) were used to assess clinical prognosis.Results The NIHSS score on admission was 13-20,and the time of procedure ranged 60-230 min.Five cases was substantial recanalized and no symptomatic intracerebral hemorrhage was observed.The NIHSS scores of the patients on day 3 after surgery were 7-19,and those were 3-17 when being discharged.One patient died of pulmonary infection 1 month after discharge.For the 5 patients who survived,the modified Rankin Scale (mRS) was evaluated at 3 months with scores of 0,2,3,3 and 5,respectively.Conclusions Endovascular therapy for acute TIM occlusions are complex,MMRT may be relatively safe and effective. Key words: Carotid artery,internal;  Middle cerebral artery;  Arterial occlusive diseases;  Radiology,interventional