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The way out is through
  1. Michael R Levitt1,
  2. Guilherme Barros2
  1. 1 Departments of Neurological Surgery, Radiology, Mechanical Engineering, and Stroke & Applied Neuroscience Center, University of Washington, Seattle, Washington, USA
  2. 2 Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Michael R Levitt, Department of Neurological Surgery, University of Washington School of Medicine, Seattle, WA 98104, USA; mlevitt{at}

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As stroke thrombectomy becomes more widely available, and the inclusion criteria more wide-ranging, tandem lesions (wherein occlusive lesions affect both the extracranial and intracranial circulation) will be encountered more frequently.1 There is considerable variability in the endovascular approach to such cases, which can include thrombectomy of the intracranial occlusion before or after the extracranial one (or as a stand-alone treatment), extracranial angioplasty with or without stent placement, and delayed surgical or endovascular treatment of the extracranial lesion. Add to these options the need for dual antiplatelet medication in the presence of thrombolytics, the possibility of infarcted territory at increased risk of hemorrhage, and the debate between surgical or endovascular treatment of carotid stenosis,2 and such cases are likely to vary both within and between institutions, and even among individual …

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  • Contributors All authors contributed equally.

  • 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.

  • Provenance and peer review Commissioned; internally peer reviewed.

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