Tandem occlusion stroke: managing a complex ICA

This recorded case presents the treatment of an 81-year-old woman admitted with a severe wake-up stroke. She presented with aphasia, facial asymmetry and left hemiplegia, corresponding to an NIHSS score of 26. MRI demonstrated early ischaemic changes with a significant diffusion-FLAIR mismatch and a large ischaemic penumbra. The patient received intravenous tenecteplase at the referring stroke centre before transfer for endovascular treatment.

Key highlights:

This case enhances several important considerations in the management of tandem occlusion stroke, from patient selection and transfer logistics to revascularisation strategy and post-procedural decision-making:

Severe wake-up stroke with a large salvageable penumbra.
Tandem occlusion involving both the common carotid artery and an intracranial M1 occlusion.
Combined aspiration and stent retriever approach using the BADDASS technique.
Complete revascularisation achieved and significant neurological recovery despite initial NIHSS 26.

Mechanical thrombectomy for right ICA tandem occlusion in a wake-up stroke patient

Stroke Recorded Case in live conditions

Key highlights:

Sign to LINNC online