{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T17:09:39Z","timestamp":1776704979134,"version":"3.51.2"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2011,6]]},"abstract":"<jats:sec>\n            <jats:title>Background and Purpose\u2014<\/jats:title>\n            <jats:p>Acute ischemic stroke due to tandem occlusions of the extracranial internal carotid artery and intracranial arteries has a poor natural history. We aimed to evaluate our single-center experience with endovascular treatment of this unique stroke population.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods\u2014<\/jats:title>\n            <jats:p>Consecutive patients with tandem occlusions of the internal carotid artery origin and an intracranial artery (ie, internal carotid artery terminus, M1 middle cerebral artery, or M2 middle cerebral artery) were studied retrospectively. Treatment consisted of proximal revascularization with angioplasty and stenting followed by intracranial intervention. Endpoints were recanalization of both extracranial and intracranial vessels (Thrombolysis In Myocardial Ischemia \u22652), parenchymal hematoma, and good clinical outcome (modified Rankin Scale \u22642) at 3 months.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results\u2014<\/jats:title>\n            <jats:p>We identified 77 patients with tandem occlusions. Recanalization occurred in 58 cases (75.3%) and parenchymal hematoma occurred in 8 cases (10.4%). Distal embolization occurred in 3 cases (3.9%). In 18 of 77 patients (23.4%), distal (ie, intracranial) recanalization was observed after proximal recanalization, obviating the need for distal intervention. Good clinical outcomes were achieved in 32 patients (41.6%). In multivariate analysis, Thrombolysis In Myocardial Ischemia \u22652 recanalization, baseline National Institutes of Health Stroke Scale score, baseline Alberta Stroke Programme Early CT score, and age were significantly associated with good outcome.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Endovascular therapy of tandem occlusions using extracranial internal carotid artery revascularization as the first step is technically feasible, has a high recanalization rate, and results in an acceptable rate of good clinical outcome. Future randomized, prospective studies should clarify the role of this approach.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.110.595520","type":"journal-article","created":{"date-parts":[[2011,4,23]],"date-time":"2011-04-23T00:13:48Z","timestamp":1303517628000},"page":"1653-1657","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":124,"title":["Endovascular Treatment of Tandem Extracranial\/Intracranial Anterior Circulation Occlusions"],"prefix":"10.1161","volume":"42","author":[{"given":"Amer M.","family":"Malik","sequence":"first","affiliation":[{"name":"From the UPMC Stroke Institute (A.M.M., N.A.V., R.L., S.F.Z., A.A., M.A.J., V.K.R., M.D.H., L.R.W., T.G.J.), University of Pittsburgh Medical Center, Pittsburgh, PA; Swedish Neuroscience Institute (A.M.M.), Swedish Medical Center, Seattle, WA; the Souers Stroke Institute and Center for Cerebrovascular Disease and Skull Base Surgery (N.A.V.), St Louis University, St Louis, MO; and the Department of Neurosurgery (B.T.J., M.B.H.), University of Pittsburgh Medical Center, Pittsburgh, PA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nirav A.","family":"Vora","sequence":"additional","affiliation":[{"name":"From the UPMC Stroke Institute (A.M.M., N.A.V., R.L., S.F.Z., A.A., M.A.J., V.K.R., M.D.H., L.R.W., T.G.J.), University of Pittsburgh Medical Center, Pittsburgh, PA; Swedish Neuroscience Institute (A.M.M.), Swedish Medical Center, Seattle, WA; the Souers Stroke Institute and Center for Cerebrovascular Disease and Skull Base Surgery (N.A.V.), St Louis University, St Louis, MO; and the Department of Neurosurgery (B.T.J., M.B.H.), University of Pittsburgh Medical Center, Pittsburgh, PA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ridwan","family":"Lin","sequence":"additional","affiliation":[{"name":"From the UPMC Stroke Institute (A.M.M., N.A.V., R.L., S.F.Z., A.A., M.A.J., V.K.R., M.D.H., L.R.W., T.G.J.), University of Pittsburgh Medical Center, Pittsburgh, PA; Swedish Neuroscience Institute (A.M.M.), Swedish Medical Center, Seattle, WA; the Souers Stroke Institute and Center for Cerebrovascular Disease and Skull Base Surgery (N.A.V.), St Louis University, St Louis, MO; and the Department of Neurosurgery (B.T.J., M.B.H.), University of Pittsburgh Medical Center, Pittsburgh, PA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Syed F.","family":"Zaidi","sequence":"additional","affiliation":[{"name":"From the UPMC Stroke Institute (A.M.M., N.A.V., R.L., S.F.Z., A.A., M.A.J., V.K.R., M.D.H., L.R.W., T.G.J.), University of Pittsburgh Medical Center, Pittsburgh, PA; Swedish Neuroscience Institute (A.M.M.), Swedish Medical Center, Seattle, WA; the Souers Stroke Institute and Center for Cerebrovascular Disease and Skull Base Surgery (N.A.V.), St Louis University, St Louis, MO; and the Department of Neurosurgery (B.T.J., M.B.H.), University of Pittsburgh Medical Center, Pittsburgh, PA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aitziber","family":"Aleu","sequence":"additional","affiliation":[{"name":"From the UPMC Stroke Institute (A.M.M., N.A.V., R.L., S.F.Z., A.A., M.A.J., V.K.R., M.D.H., L.R.W., T.G.J.), University of Pittsburgh Medical Center, Pittsburgh, PA; Swedish Neuroscience Institute (A.M.M.), Swedish Medical Center, Seattle, WA; the Souers Stroke Institute and Center for Cerebrovascular Disease and Skull Base Surgery (N.A.V.), St Louis University, St Louis, MO; and the Department of Neurosurgery (B.T.J., M.B.H.), University of Pittsburgh Medical Center, Pittsburgh, PA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian T.","family":"Jankowitz","sequence":"additional","affiliation":[{"name":"From the UPMC Stroke Institute (A.M.M., N.A.V., R.L., S.F.Z., A.A., M.A.J., V.K.R., M.D.H., L.R.W., T.G.J.), University of Pittsburgh Medical Center, Pittsburgh, PA; Swedish Neuroscience Institute (A.M.M.), Swedish Medical Center, Seattle, WA; the Souers Stroke Institute and Center for Cerebrovascular Disease and Skull Base Surgery (N.A.V.), St Louis University, St Louis, MO; and the Department of Neurosurgery (B.T.J., M.B.H.), University of Pittsburgh Medical Center, Pittsburgh, PA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mouhammad A.","family":"Jumaa","sequence":"additional","affiliation":[{"name":"From the UPMC Stroke Institute (A.M.M., N.A.V., R.L., S.F.Z., A.A., M.A.J., V.K.R., M.D.H., L.R.W., T.G.J.), University of Pittsburgh Medical Center, Pittsburgh, PA; Swedish Neuroscience Institute (A.M.M.), Swedish Medical Center, Seattle, WA; the Souers Stroke Institute and Center for Cerebrovascular Disease and Skull Base Surgery (N.A.V.), St Louis University, St Louis, MO; and the Department of Neurosurgery (B.T.J., M.B.H.), University of Pittsburgh Medical Center, Pittsburgh, PA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vivek K.","family":"Reddy","sequence":"additional","affiliation":[{"name":"From the UPMC Stroke Institute (A.M.M., N.A.V., R.L., S.F.Z., A.A., M.A.J., V.K.R., M.D.H., L.R.W., T.G.J.), University of Pittsburgh Medical Center, Pittsburgh, PA; Swedish Neuroscience Institute (A.M.M.), Swedish Medical Center, Seattle, WA; the Souers Stroke Institute and Center for Cerebrovascular Disease and Skull Base Surgery (N.A.V.), St Louis University, St Louis, MO; and the Department of Neurosurgery (B.T.J., M.B.H.), University of Pittsburgh Medical Center, Pittsburgh, PA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maxim D.","family":"Hammer","sequence":"additional","affiliation":[{"name":"From the UPMC Stroke Institute (A.M.M., N.A.V., R.L., S.F.Z., A.A., M.A.J., V.K.R., M.D.H., L.R.W., T.G.J.), University of Pittsburgh Medical Center, Pittsburgh, PA; Swedish Neuroscience Institute (A.M.M.), Swedish Medical Center, Seattle, WA; the Souers Stroke Institute and Center for Cerebrovascular Disease and Skull Base Surgery (N.A.V.), St Louis University, St Louis, MO; and the Department of Neurosurgery (B.T.J., M.B.H.), University of Pittsburgh Medical Center, Pittsburgh, PA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lawrence R.","family":"Wechsler","sequence":"additional","affiliation":[{"name":"From the UPMC Stroke Institute (A.M.M., N.A.V., R.L., S.F.Z., A.A., M.A.J., V.K.R., M.D.H., L.R.W., T.G.J.), University of Pittsburgh Medical Center, Pittsburgh, PA; Swedish Neuroscience Institute (A.M.M.), Swedish Medical Center, Seattle, WA; the Souers Stroke Institute and Center for Cerebrovascular Disease and Skull Base Surgery (N.A.V.), St Louis University, St Louis, MO; and the Department of Neurosurgery (B.T.J., M.B.H.), University of Pittsburgh Medical Center, Pittsburgh, PA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael B.","family":"Horowitz","sequence":"additional","affiliation":[{"name":"From the UPMC Stroke Institute (A.M.M., N.A.V., R.L., S.F.Z., A.A., M.A.J., V.K.R., M.D.H., L.R.W., T.G.J.), University of Pittsburgh Medical Center, Pittsburgh, PA; Swedish Neuroscience Institute (A.M.M.), Swedish Medical Center, Seattle, WA; the Souers Stroke Institute and Center for Cerebrovascular Disease and Skull Base Surgery (N.A.V.), St Louis University, St Louis, MO; and the Department of Neurosurgery (B.T.J., M.B.H.), University of Pittsburgh Medical Center, Pittsburgh, PA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tudor G.","family":"Jovin","sequence":"additional","affiliation":[{"name":"From the UPMC Stroke Institute (A.M.M., N.A.V., R.L., S.F.Z., A.A., M.A.J., V.K.R., M.D.H., L.R.W., T.G.J.), University of Pittsburgh Medical Center, Pittsburgh, PA; Swedish Neuroscience Institute (A.M.M.), Swedish Medical Center, Seattle, WA; the Souers Stroke Institute and Center for Cerebrovascular Disease and Skull Base Surgery (N.A.V.), St Louis University, St Louis, MO; and the Department of Neurosurgery (B.T.J., M.B.H.), University of Pittsburgh Medical Center, Pittsburgh, PA."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.0000237070.80133.1d"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.0000185924.22918.51"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.32.6.1330"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12350-009-9084-y"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1159\/000145326"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A1163"},{"key":"e_1_3_2_8_2","first-page":"164","article-title":"Pretreatment ipsilateral regional cortical blood flow influences vessel recanalization in intra-arterial thrombolysis for MCA occlusion","volume":"28","author":"Jovin TG","year":"2007","unstructured":"Jovin TG, Gupta R, Horowitz MB, Grahovac SZ, Jungreis CA, Wechsler L, Gebel JM, Yonas H. 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