Combined interventional and surgical treatment of tandem middle cerebral artery embolus and internal carotid artery occlusion: Case report

Mark B. Frenkel, Jaclyn J. Renfrow, Jasmeet Singh, Nitin Garg, Stacey Q. Wolfe

Research output: Contribution to journalArticle

4 Scopus citations


Tandem internal carotid artery (ICA) origin occlusion and middle cerebral artery (MCA) thromboembolism is a life-threatening condition with poor neurological outcome. The authors report on a patient presenting with acute ischemic stroke from a tandem ICA and MCA occlusion with penumbra. Emergency MCA mechanical thrombectomy was performed through percutaneous cervical ICA access due to the inability to cross the cervical carotid occlusion. Emergency carotid endarterectomy to reperfuse the poorly collateralized hemisphere and repair the ICA access site was performed 2 hours after completion of tissue plasminogen activator (tPA) infusion. This case illustrates the shortest reported interval between tPA infusion and open surgical intervention for carotid revascularization, as well as the role of direct carotid artery access for mechanical thrombectomy. The authors also describe the use of a temporizing femoral artery-to-ICA shunt to maintain cerebral perfusion in the setting of ICA occlusion.

Original languageEnglish (US)
Pages (from-to)718-722
Number of pages5
JournalJournal of neurosurgery
Issue number3
StatePublished - Sep 2018



  • Carotid endarterectomy
  • Intracranial thrombectomy
  • Stroke
  • TPA
  • Tandem occlusion
  • Vascular disorders

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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