2017 Volume 2 Issue 1 Pages 31-35
Objective: A case of acute ischemic stroke involving intracranial middle cerebral artery and extracranial internal carotid artery (tandem lesions) requires some ingenuity to select appropriate revascularization devices in treatment. A case of tandem lesions treated by means of carotid artery stenting and revascularization devices was reported.
Case Presentation: A 66-year-old man was found lying on the floor, and was transferred to our hospital. The scores of neurological evaluation were as follows: Japan Coma Scale (JCS) 100, Glasgow Come Scale (GCS) 9 (E1V3M5) and National Institute of Health Stroke Scale (NIHSS) 31. The patient presented with left hemiparesis (Manual Muscle Test [MMT] 0/5). CT revealed no intracranial hemorrhage and cerebral infarction. MRI revealed no acute cerebral infarction, however, MRA revealed an occlusion of the right internal carotid artery (ICA). Within two hours after the onset of stroke, rt-PA was administered. NIHSS was improved to 11. Angiogram revealed an occlusion of the origin of the right ICA and the right middle cerebral artery. Recanalization (TICI IIb) was achieved by means of carotid artery stenting (CAS) and revascularization devices. Although the patient presented with dysarthria and left incomplete hemiparesis (MMT 3/5~4/5) after treatment, he could complete personal care. A modified Rankin Scale at the time of discharge was two.
Conclusion: Recanalization for an ischemic stroke due to tandem lesions by means of CAS and revascularization devices was useful, however, appropriate selection of patient and appropriate selection of revascularization devices were required.
