Tandem Occlusions

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Stroke

• General
• Two separate occlusions
• Low re-canalisation rates following thrombolysis
• High rates of arterial re-occlusion
• Independent predictor of poor clinical outcome.
• Two separate occlusions i.e ICA and MCA

• Pathology
• Pathological thickening of the common or internal carotid intima into focal areas (plaques).
• Can remain stable for many years
• Surface rupture of unstable plaques → thrombosis → embolisation.
• Amaurosis fugax, contralateral TIA / stroke.

• Imaging
• Ultrasound Doppler— within 24 hours of new TIA / non-disabling stroke / amaurosis
• CT angiography
• MRI angiography
• Catheter angiography (obsolete)

• Treatments
• Zevallkos 2022: A retrograde approach to carotid artery stenting had higher odds of successful reperfusion and good functional outcomes at 3 months than balloon angioplasty and an anterograde approach in patients with tandem occlusions.