{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T15:59:56Z","timestamp":1781539196774,"version":"3.54.5"},"reference-count":10,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n<jats:title>Background: <\/jats:title>\n<jats:p>Acute tandem occlusions, or occlusions of the extracranial portion of the internal carotid artery (ICA) with concurrent thromboembolism of the intracranial ICA or middle cerebral artery, poses a major clinical challenge, with patients suffering worse outcomes compared to those with single occlusions. Management of these lesions generally includes a combination of mechanical thrombectomy (MT) of the intracranial occlusion and stenting of the extracranial carotid lesion. In this manuscript, we describe a successful surgical method for achieving revascularization of tandem occlusions in the rare circumstance that the proximal lesion cannot be crossed endovascularly to gain intracranial access.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st2\">\n<jats:title>Methods: <\/jats:title>\n<jats:p>Despite using our institution\u2019s standard protocol for achieving revascularization of such lesions, the extracranial occlusion could not be crossed endovascularly, and the case was converted to an emergent carotid endarterectomy (CEA) in the operating room. Once the endarterectomy was complete, intraoperative MT was performed before cervical incision closure to revascularization.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st3\">\n<jats:title>Results: <\/jats:title>\n<jats:p>The patient recovered well postoperatively and was discharged with NIHSS of 2 due to minor facial palsy and minor dysarthria. Thirty-day follow-up revealed resolution of the prior neurologic deficits and an mRS of 1.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st4\">\n<jats:title>Conclusion: <\/jats:title>\n<jats:p>Emergent CEA should be considered in the rare circumstance of being unable to cross the cervical occlusion during management of acute ischemic stroke with tandem occlusion.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_740_2022","type":"journal-article","created":{"date-parts":[[2022,11,11]],"date-time":"2022-11-11T05:26:44Z","timestamp":1668144404000},"page":"521","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Emergent carotid endarterectomy and mechanical thrombectomy in tandem occlusion"],"prefix":"10.25259","volume":"13","author":[{"given":"Danielle","family":"Hebert","sequence":"first","affiliation":[{"name":"Department of General Surgery, Central Michigan University College of Medicine, Michigan, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa A.","family":"Elder","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph G.","family":"Adel","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Ascension St. Mary\u2019s Hospital, Saginaw, Michigan, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2022,11,11]]},"reference":[{"key":"10.25259\/SNI_740_2022\/ref-1","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1186\/s12883-021-02393-4","article-title":"Acute ischemic stroke with cervical internal carotid artery steno-occlusive lesion: Multicenter analysis of endovascular approaches","volume":"21","author":"Cirillo","year":"2021","journal-title":"BMC Neurol"},{"key":"10.25259\/SNI_740_2022\/ref-2","doi-asserted-by":"crossref","first-page":"177","DOI":"10.25259\/SNI_176_2022","article-title":"Cervical carotid occlusion in acute ischemic stroke: Should we give tPA?","volume":"13","author":"Elder","year":"2022","journal-title":"Surg Neurol Int"},{"key":"10.25259\/SNI_740_2022\/ref-3","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1159\/000496292","article-title":"Head or neck first? Speed and rates of reperfusion in thrombectomy for tandem large vessel occlusion strokes","volume":"8","author":"Haussen","year":"2020","journal-title":"Interv Neurol"},{"key":"10.25259\/SNI_740_2022\/ref-4","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1093\/bja\/aem137","article-title":"Carotid endarterectomy","volume":"99","author":"Howell","year":"2007","journal-title":"Br J Anaesth"},{"key":"10.25259\/SNI_740_2022\/ref-5","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1136\/neurintsurg-2013-011004","article-title":"Intra-arterial treatment of patients with acute ischemic stroke and internal carotid artery occlusion: A literature review","volume":"7","author":"Kappelhof","year":"2015","journal-title":"J Neurointerv Surg"},{"key":"10.25259\/SNI_740_2022\/ref-6","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.ejvs.2008.12.003","article-title":"Urgent carotid surgery in patients with crescendo transient ischaemic attacks and stroke-in-evolution: A systematic review","volume":"37","author":"Karkos","year":"2009","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"10.25259\/SNI_740_2022\/ref-7","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1161\/01.STR.0000160007.57787.4c","article-title":"Early recanalization rates and clinical outcomes in patients with tandem internal carotid artery\/middle cerebral artery occlusion and isolated middle cerebral artery occlusion","volume":"36","author":"Kim","year":"2005","journal-title":"Stroke"},{"key":"10.25259\/SNI_740_2022\/ref-8","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1007\/s00234-014-1465-5","article-title":"Mechanical thrombectomy in tandem occlusion: Procedural considerations and clinical results","volume":"57","author":"Lockau","year":"2015","journal-title":"Neuroradiology"},{"key":"10.25259\/SNI_740_2022\/ref-9","doi-asserted-by":"crossref","first-page":"2301","DOI":"10.1161\/01.STR.0000237070.80133.1d","article-title":"Tandem internal carotid artery\/ middle cerebral artery occlusion: An independent predictor of poor outcome after systemic thrombolysis","volume":"37","author":"Rubiera","year":"2006","journal-title":"Stroke"},{"key":"10.25259\/SNI_740_2022\/ref-10","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1177\/1747493020929948","article-title":"Effect of emergent carotid stenting during endovascular therapy for acute anterior circulation stroke patients with tandem occlusion: A multicenter, randomized, clinical trial (TITAN) protocol","volume":"16","author":"Zhu","year":"2021","journal-title":"Int J Stroke"}],"container-title":["Surgical Neurology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/surgicalneurologyint.com\/emergent-carotid-endarterectomy-and-mechanical-thrombectomy-in-tandem-occlusion\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/emergent-carotid-endarterectomy-and-mechanical-thrombectomy-in-tandem-occlusion\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,11]],"date-time":"2022-11-11T05:26:50Z","timestamp":1668144410000},"score":1,"resource":{"primary":{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/emergent-carotid-endarterectomy-and-mechanical-thrombectomy-in-tandem-occlusion\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,11]]},"references-count":10,"alternative-id":["10.25259\/SNI_740_2022"],"URL":"https:\/\/doi.org\/10.25259\/sni_740_2022","relation":{},"ISSN":["2152-7806"],"issn-type":[{"value":"2152-7806","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,11]]},"article-number":"521"}}