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<p>Although tandem atherosclerosis and tandem lesions (defined as the simultaneous presence of stenosis or occlusion of the cervical internal carotid artery and thromboembolic occlusion of the intracranial terminal internal carotid artery or its branches) have been extensively studied; however, their treatment did not reach a consensus, and it is still debatable. An 86-year-old male patient who presented clinically with left-sided weakness (hemiparesis), dizziness, and several syncopal episodes was transported and admitted to our clinic (initially in the neurology department). The imaging studies revealed occlusion of the right internal carotid artery (ICA) C2 segment and concomitant occlusion of the distal part of the M1 segment of the right middle cerebral artery (MCA; TO). As these complex lesions may present a challenge for treatment decision-making and although mechanical thrombectomy in the M1 segment of MCA ischemic stroke has a documented proven benefit, alternative treatment variants have to be taken very seriously into consideration. We, therefore, present the clinical case of an older patient with thromboembolism of C2 segment of the right ICA and the distal M1 segment of the right MCA who was successfully treated with mechanical thrombectomy (distal M1 segment of right MCA; distal revascularization technique), and give a concise review of the recent existing and known literature, the controversy regarding its association with cerebral infarcts, and comparison of various methods, approaches and options used in the therapy of such complex occlusive changes. The neurological symptoms of the patient disappeared on control examination, and postoperative CTA showed no residual right MCA occlusion nor residual stenosis, thus providing insights into another very important therapeutic alternative for distal M1 segment MCA stroke. Our case is another example of endovascular treatment that is effective in patients with anterior vascular circulation system stroke, even with distal M1 occlusion, without prior IV thrombolysis, and initial non-favorable survival parameters (absence of good clinical outcome—CO predictors; paradoxically), and could potentially be a superior approach in the future.</p>

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The Role and Significance of Computed Tomography Angiography (CTA) and Mechanical Neuro Thrombectomy in the Diagnosis and Therapy of Complex Tandem Occlusion: Clinical Case Report and Review of Literature

  • 期刊论文

  • 发表日期：

    2025年5月14日

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  • Dusan J. Petrovic,
  • Dragoslav Nestorovic

摘要

Although tandem atherosclerosis and tandem lesions (defined as the simultaneous presence of stenosis or occlusion of the cervical internal carotid artery and thromboembolic occlusion of the intracranial terminal internal carotid artery or its branches) have been extensively studied; however, their treatment did not reach a consensus, and it is still debatable. An 86-year-old male patient who presented clinically with left-sided weakness (hemiparesis), dizziness, and several syncopal episodes was transported and admitted to our clinic (initially in the neurology department). The imaging studies revealed occlusion of the right internal carotid artery (ICA) C2 segment and concomitant occlusion of the distal part of the M1 segment of the right middle cerebral artery (MCA; TO). As these complex lesions may present a challenge for treatment decision-making and although mechanical thrombectomy in the M1 segment of MCA ischemic stroke has a documented proven benefit, alternative treatment variants have to be taken very seriously into consideration. We, therefore, present the clinical case of an older patient with thromboembolism of C2 segment of the right ICA and the distal M1 segment of the right MCA who was successfully treated with mechanical thrombectomy (distal M1 segment of right MCA; distal revascularization technique), and give a concise review of the recent existing and known literature, the controversy regarding its association with cerebral infarcts, and comparison of various methods, approaches and options used in the therapy of such complex occlusive changes. The neurological symptoms of the patient disappeared on control examination, and postoperative CTA showed no residual right MCA occlusion nor residual stenosis, thus providing insights into another very important therapeutic alternative for distal M1 segment MCA stroke. Our case is another example of endovascular treatment that is effective in patients with anterior vascular circulation system stroke, even with distal M1 occlusion, without prior IV thrombolysis, and initial non-favorable survival parameters (absence of good clinical outcome—CO predictors; paradoxically), and could potentially be a superior approach in the future.