Simultaneous Approach to Tandem Occlusion in Acute Ischemic Stroke Patients: Percutaneous Transluminal Angioplasty (PTA) Using Push Wire of Stent Retriever

Objective: For patients with tandem occlusion (TO), it is controversial whether an antegrade approach or retrograde approach should be undertaken. Here, we report our strategy for treating patients with TO by simultaneous approach. First, a microcatheter was advanced to the distal occlusion site along with a microwire. Second, a stent retriever (SR) was deployed as an anchor at the distal lesion, and percutaneous transluminal angioplasty (PTA) was performed at the proximal lesion using push wire of SR. After that, the microwire was removed and PTA balloon as well as the guiding catheter (GC) was advanced along the wire of SR. Finally, the SR was withdrawn with clot. Case Presentations: Cases 1 and 2, who were confi rmed as TO, were treated by the method described above. We could re-perfuse successfully. These two cases had favorable outcomes, indicating a modifi ed Rankin scale 2 at the time of discharge. Conclusion: Our therapeutic strategy for TO might be useful for early reperfusion of a distal occlusion site and associated with favorable outcome.