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An Uncommon Case of Carotid Artery Tandem Lesion - Difficult Management Decision and Literature Review

Shoaib RF, O’Brien A, Siddique A, Sinha DM, Lognathan T and Guyler PC

We report a case of 84 years old lady who was admitted to our acute stroke unit with two episodes of tingling and numbness in left arm over last seventy two hours. Magnetic Resonance Imaging (MRI) showed right posterior parietal infarction. Subsequent carotid vascular imaging confirmed right internal carotid artery and right brachiocephalic significant stenosis. Her case was discussed in stroke/vascular surgery multidisciplinary team meeting and than with interventional radiology team at one of our tertiary referral centres and she was transferred. She underwent retrograde angioplasty with stent insertion at right brachiocephalic origin. Carotid endarterectomy was deferred as a preprocedure carotid angiogram showed right internal carotid artery stenosis of less than 50%. She made very good recovery with no complications and was discharged from hospital on day seven.