NAVIGATING COMPLEXITIES IN ISCHEMIC STROKE MANAGEMENT: A CASE STUDY OF TANDEM ARTERIAL OCCLUSIONS AND ENDOVASCULAR INTERVENTION.

Introduction: Stroke is a common medical condition where the blood flow of the brain is suddenly stopped, leading to different neurological deficits. It mostly affects individuals aged 55 or above, but it can occur at any age. The stroke can come as an ischemic stroke, hemorrhagic stroke or even transient ischemic stroke. The most common type is the ischemic stroke, which can further come as large artery atherosclerosis, cardioembolic, small vessel disease, or other forms. Case Report: We present the case of a 37-year-old male patient who suffered an ischemic stroke. The patient underwent a comprehensive treatment protocol, including endovascular thrombectomy, following the identification of an obstruction of the internal carotid artery. Prior to the intervention, the patient underwent radiological and imaging investigations at the radiology department, where several CT scans were performed. The patient was referred to our clinic after a thorough neurological examination, with tandem stroke, trough simultaneous occlusion of the cervical segment of the internal carotid artery, and middle cerebral artery. Initially, aspiration thrombectomy was attempted using an aspiration catheter, yielding only partial success. Eventually, combined thrombectomy was performed, where an aspiration catheter alongside a stent retriever was deployed, to capture the thrombus. The procedure was complicated by the thrombus fragmentation and migration into the upper trunk of the middle cerebral artery. After numerous attempts, successful recanalization was obtained, with the ischemic stroke attributed to an embolic thrombus originating from the heart, associated with the patient's atrial fibrillation. Discussions : The presented case highlights the complexity often encountered in managing ischemic strokes, particularly in younger patients. The use of a comprehensive treatment approach, including endovascular thrombectomy, highlights the evolving landscape of stroke management, where timely intervention is crucial to mitigate potential long-term neurological deficits. The tandem occlusion of the cervical segment of the internal carotid artery and middle cerebral artery poses an incredible challenge, employing innovative strategies such as combined thrombectomy to address the obstruction effectively. Conclusions: In conclusion, this case highlights the challenges and complexities in managing ischemic strokes, particularly when tandem arterial occlusions occur with embolic origin. Despite procedural difficulties, successful recanalization was achieved, emphasizing the importance of strategizing, adaptability and perseverance in stroke interventions. [ABSTRACT FROM AUTHOR]