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Review
. 2020 Jul;41(7):1142-1148.
doi: 10.3174/ajnr.A6582. Epub 2020 Jun 4.

Tandem Carotid Lesions in Acute Ischemic Stroke: Mechanisms, Therapeutic Challenges, and Future Directions

A Y Poppe  1   2 , G Jacquin  3   2 , D Roy  4 , C Stapf  3   2 , L Derex  5   6
Affiliations
Review

Tandem Carotid Lesions in Acute Ischemic Stroke: Mechanisms, Therapeutic Challenges, and Future Directions

A Y Poppe et al. AJNR Am J Neuroradiol. 2020 Jul.

Abstract

Approximately 15% of patients undergoing endovascular thrombectomy for anterior circulation acute ischemic stroke have a tandem lesion, defined as a severe stenosis or occlusion of the cervical internal carotid artery ipsilateral to its intracranial occlusion. Patients with tandem lesions have worse outcomes than patients with isolated intracranial occlusions, but the optimal management of their carotid lesions during endovascular thrombectomy remains controversial. The main options commonly used in current practice include acute stent placement in the carotid lesion versus thrombectomy alone without definitive revascularization of the carotid artery. While treatment decisions for these patients are often complex and strategies vary according to clinical, anatomic, and technical considerations, only results from randomized trials comparing these approaches are likely to strengthen current recommendations and optimize patient care.

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Figures

FIG 1.
FIG 1.
Schematic summarizing the main approaches to managing cervical carotid lesions in patients with tandem occlusions undergoing thrombectomy for acute stroke. CEA indicates carotid endarterectomy; CAS, carotid artery stent placement.
FIG 2.
FIG 2.
Clinical and radiologic factors influencing the decision to favor acute stent placement or no stent placement for patients with tandem lesions undergoing thrombectomy.
See this image and copyright information in PMC

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