BACKGROUND Acute ischemic stroke due to tandem occlusive lesions of the anterior circulation involves an intracranial large vessel occlusion as well as a concurrent occlusion or high-grade stenosis of the proximal carotid system. The vast majority of proximal lesions in tandem occlusive cases involve the extracranial internal carotid artery, although the lesion can theoretically exist anywhere along the carotid artery pathway, including the common carotid ostium. SUMMARY To the best of our knowledge, only 1 report describes common carotid artery ostial lesions in the setting of acute ischemic stroke due to tandem occlusions, in which the authors describe an anterograde treatment paradigm. We present the first 2 cases of acute ischemic stroke secondary to common carotid ostial disease with tandem intracranial occlusion, treated with intracranial thrombectomy followed by subsequent staged balloon-mounted stenting of the common carotid ostium. We review the pathophysiology of tandem occlusions, the controversy surrounding treatment techniques, and various approaches used in the treatment of ostial occlusive lesions. KEY MESSAGE In certain situations where acute carotid stenting is not safe or technically possible, immediate intracranial thrombectomy with a subsequent staged balloon-mounted stenting of the ostial lesion may be a reasonable and safe option.

中文翻译：

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血栓切除术和分期逆行支架术治疗因颈总动脉开口部疾病伴串联颅内闭塞引起的急性缺血性中风。

背景技术由于前循环的串联闭塞性病变引起的急性缺血性中风涉及颅内大血管闭塞以及近端颈动脉系统的并发闭塞或高度狭窄。在串联闭塞病例中，绝大多数近端病变涉及颅外颈内动脉，尽管理论上病变可以存在于颈动脉通路沿线的任何地方，包括颈总动脉口。总结 据我们所知，只有 1 份报告描述了由于串联闭塞引起的急性缺血性卒中的颈总动脉开口病变，其中作者描述了顺行治疗范例。我们介绍了前 2 例继发于颈总动脉开口部疾病伴串联颅内闭塞的急性缺血性卒中，采用颅内血栓切除术治疗，随后对颈总动脉口进行分期球囊支架置入术。我们回顾了串联闭塞的病理生理学、围绕治疗技术的争议以及用于治疗开口闭塞病变的各种方法。关键信息 在某些情况下，急性颈动脉支架置入术不安全或技术上不可行，立即进行颅内血栓切除术并随后对开口病变进行分期球囊支架置入术可能是一种合理且安全的选择。