A clinical case of mechanical recanalization of recurrent cerebral embolism in the hyperacute period of ischemic stroke with hemorrhagic transformation

Currently, there is no single algorithm for the treatment of acute tandem occlusion of the internal carotid artery (ICA) and middle cerebral artery (MCA). The article presents the clinical case of ischemic stroke, which developed 10 days after the first ischemic episode with hemorrhagic transformation. As reperfusion therapy, thrombectomy from the M1 segment of the left MCA and simultaneous stenting of the left ICA were performed. The use of dual antiplatelet therapy at a loading dose in this clinical case was justified by the risk of stent thrombosis, but this increased the risk of recurrent hemorrhagic transformation. Follow-up of the patient for 90 days after this vascular event showed a favorable clinical outcome without hemorrhagic complications. The presented clinical case is extremely rare and shows one of the possible approaches in the management of patients with tandem lesions of the brachiocephalic arteries with a history of intracranial hemorrhagic complications. To develop a unified algorithm for managing acute tandem occlusion in recurrent ischemic strokes, more observations are needed.