Masterclass #6: Attacking a tandem stroke: a strategic or technical concern or both?

Italo LINFANTE, Marc RIBO, Vitor MENDES PEREIRA, Jacques MORET, Laurent SPELLE

Being in tandem can be a positive experience, but a tandem stroke? What’s lurking behind the first occlusion? And how do you manage your patient?

Join Professors Jacques Moret, Laurent Spelle and their expert panel as they explore two cases illustrating tandem strokes involving atherosclerotic lesions. Learn why Prof. Spelle says, “Get to the top – even if you can’t see the top from the bottom!”

Enter the dialogue, exploring the clinical challenges facing treatment of tandem lesions such as:

• Would you use general anesthesia or conscious sedation…or no anesthesia at all?
• How would you begin – Stenting or dilatation? Head or neck?
• What antiplatelet regime would you employ?
• How do you control arterial pressure?
• What technique to use? Balloon angioplasty; intracranial thrombectomy then carotid stenting? The “BADASS” technique?
• What would you do if a stent gets occluded during the intervention?
• What danger does debris pose in treating tandem lesions and how should this be managed?
• And more…

Two cases involving complete and incomplete tandem occlusions are presented…