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. 2020 Jan-Feb;23(1):13–19. doi: 10.4103/aian.AIAN_359_19

Figure 4.

Figure 4

(original) Approach to Tandem occlusion; (a) Note occlusion in the M1 MCA (black arrow) and atherosclerotic tight stenosis at the origin of the ICA (Bold black arrow), (b) Step 1: Balloon angioplasty of the ICA stenosis/occlusion with a 2-mm diameter balloon (c) Step 2: Management of distal occlusion; A large bore 6-F catheter is taken across and parked in the cervical ICA (black arrow), following this the Stentriever is deployed across the clot and thrombectomy performed (bold arrow); aspiration technique can be adopted as well. (d) Note retrieval of the MCA clot. Then the proximal stenosis can be either be managed by angioplasty alone (e) or stenting (f) (bold arrow)