Case series of acute ischemic stroke with tandem lesions of intracranial large vessel occlusion and cervical internal carotid artery stenosis or occlusion

• Published in: Japanese Journal of Stroke Vol. 43; no. 2; pp. 158 - 166
• Main Authors: Otsuka, Hiroaki, Hiu, Takeshi, Kawahara, Ichiro, Iwanaga, Hiroshi, Chikamatsu, Genki, Matsuo, Ayaka, Ono, Tomonori, Haraguchi, Wataru, Ushijima, Ryujiro, Tsutsumi, Keisuke
• Format: Journal Article
• Language: Japanese
• Published: The Japan Stroke Society 2021
• Subjects: cervical internal carotid artery stenosis; emergency carotid artery stenting; stent thrombosis; tandem lesions; thrombectomy
• ISSN: 0912-0726; 1883-1923
• DOI: 10.3995/jstroke.10786

Background and purpose: Regarding the treatment of acute ischemic stroke with tandem lesions of intracranial large vessel occlusion and cervical internal carotid artery (ICA) stenosis/occlusion, whether or not angioplasty for cervical ICA lesions should be performed in the acute stage is controversial. We investigated several cases of acute cerebral infarction with tandem lesions. Methods: We retrospectively analyzed five patients with tandem lesions who underwent thrombectomy from 2015 to 2018 in our hospital. Results: Recombinant tissue-type plasminogen activator was not used in any of the five patients with tandem lesions because it was contraindicated. In three patients, emergency carotid artery stenting (CAS) in addition to thrombectomy was performed. The antegrade technique (CAS first) was selected for one patient, and the retrograde technique (thrombectomy first) was used for the other patients. Successful recanalization was achieved in all patients. In one patient, stent thrombosis occurred during treatment. In the last two patients, only thrombectomy was performed in the acute stage because the moderate stenosis of the cervical ICA had not progressed during thrombectomy. One patient with carotid web had recurrence of infarction and received second thrombectomy. These patients underwent carotid endarterectomy (CEA) in the chronic stage. Conclusion: If the Penumbra system can pass through the stenotic lesion in the cervical ICA, a retrograde technique can be selected. Emergency CAS with thrombectomy has the potential to induce stent thrombosis. CAS or CEA should be considered as early as possible in patients even with moderate stenosis.