CardioVascular and Interventional Radiology

, Volume 38, Issue 2, pp 304–313 | Cite as

Acute Stroke and Obstruction of the Extracranial Carotid Artery Combined with Intracranial Tandem Occlusion: Results of Interventional Revascularization

  • Stephanie Lescher
  • Katja Czeppan
  • Luciana Porto
  • Oliver C. Singer
  • Joachim Berkefeld
Clinical Investigation



Due to high thrombus load, acute stroke patients with tandem obstructions of the extra- and intracranial carotid arteries or the middle cerebral artery show a very limited response to systemic thrombolysis. Interventional treatment with mechanical thrombectomy—often in combination with acute stenting of underlying atherosclerotic stenosis or dissection—is increasingly used. It has been shown that such complex interventions are technically feasible. The lack of optimal management strategies and clinical data encouraged us to review our acute stroke interventions in patient with anterior circulation tandem lesions to determine lesion patterns, interventional approaches, and angiographic or clinical outcomes.

Patients and Methods

We retrospectively analyzed a series of 39 consecutive patients with intracranial vessel occlusion of the anterior circulation simultaneously presenting with high-grade cervical internal carotid artery (ICA) stenosis or occlusion.


Emergency ICA stent implantation was technically feasible in all patients, and intracranial recanalization with TICI ≥ 2b was reached in a large number of patients (64 %). Good clinical outcomes (mRS ≤ 2 at 3 months) were achieved in one third of the patients (36 %). Symptomatic hemorrhages occurred in four patients (10 %). Mortality was 10 %.


Endovascular recanalization of acute cervical carotid artery occlusion was technically feasible in all patients, and resulted in high extra- and intracranial revascularization rates. A trend for favorable clinical outcome was seen in a higher TICI score, younger age, good collateral status, and combined IV rTPA and endovascular therapy.


Acute stroke Internal carotid artery occlusion Endovascular recanalization Outcome 


Conflict of interest

Joachim Berkefeld is a member of the scientific advisory board of Acandis. The other authors have nothing to disclose.

Ethical Standard

In accordance with the rules of the local ethic committee, a formal consent is not required for this type of study (retrospective analysis of data).

Statement of Human and Animal Rights

The study has been approved by the appropriate institutional ethics committee and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Statement of Informed Consent

For our study informed consent was not obtained due to its retrospective study design with retrospective analysis of preexisting datasets.


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Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2014

Authors and Affiliations

  • Stephanie Lescher
    • 1
  • Katja Czeppan
    • 1
  • Luciana Porto
    • 1
  • Oliver C. Singer
    • 2
  • Joachim Berkefeld
    • 1
  1. 1.Institute of NeuroradiologyHospital of Goethe UniversityFrankfurt am MainGermany
  2. 2.Department of NeurologyHospital of Goethe UniversityFrankfurt am MainGermany

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