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Case report
Tandem occlusion involving accessory middle cerebral artery in acute ischaemic stroke: management strategies
  1. Nirmalya Ray,
  2. Jagadeesan Dhanasekaran,
  3. Santhosh Joseph and
  4. Laxmikanth Jella
  1. Neuroradiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamilnadu, India
  1. Correspondence to Dr Nirmalya Ray; ray.nirmalya20{at}


Occlusion of both the limbs of accessory middle cerebral artery (AMCA) poses a unique challenge in management of acute ischaemic stroke by mechanical thrombectomy. The patient is a 30-year-old man, presenting with acute onset of left-sided hemiparesis for 4 hours. Non-contrast CT brain showed no bleed and three-dimensional CT angiogram of head and neck vessels showed dissection involving right carotid bulb and tandem occlusion of right MCA with presence of two MCA stumps. Aspiration thrombectomy was done using a reperfusion catheter, advanced separately into both the MCA stumps and complete recanalisation of both the limbs of MCAs was achieved, which was found to be AMCA. Balloon angioplasty for the internal carotid artery dissection was performed. Although occlusion of AMCA in acute ischaemic stroke is a chance occurrence, it is important to identify this variant as recanalisation of both the limbs by mechanical thrombectomy is required for favourable outcome after the procedure.

  • stroke
  • interventional radiology
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  • Contributors NR and JD performed the case, designed the research and wrote the manuscript. SJ and LJ compiled the data and wrote the manuscript. All authors critically revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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