Resolution of complex tandem stroke caused by carotid loop acute dissection using a distal anchorage-stent facilitating technique

Abstract

Tandem stroke caused by a cervical carotid loop acute dissection with distal embolism is generally a challenging procedure for the neurointerventionalist. The loop section of the dissected artery difficults quick access to the distal occlusion and it is also a complicated lesion to treat itself, due to complex navigation and re-thrombosis that precludes in situ angioplasty and/or definite stenting. ^{1 – 6} We present a patient with an acute tandem Middle Cerebral Artery (MCA) and Internal Carotid Artery (ICA) occlusion due to an underlying carotid loop dissection. After several failed attempts to fully angioplasty or stent the ICA dissection and gain definite optimal access to the distal occlusion, an effective treatment was achieved by a distal anchoring technique: navigation with a microcatheter and full opening of a 6/40 stentriever in the distal MCA occlusion facilitated the advancement of the 8F guide catheter through the dissected ICA and straightened the loop segment of the artery, thus permitting the retrieval of the distal clot and the posterior definite stenting of the dissected ICA segment while retrieving the guide catheter. This simple manoeuvre can be a treatment option for patients and colleagues in this difficult setting.