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Stent retriever for Tandem Acute Revascularization Technique (START): a novel technique for the endovascular management of tandem occlusions
  1. Areej Fageeh1,2,3,
  2. Gil Zur1,3,
  3. Ange Diouf1,3,
  4. Daniel La Russa1,4,
  5. Brian Drake1,2,3,4,
  6. Marlise P dos Santos1,3,4,
  7. Katie Caron1,
  8. Nicole Birch1,
  9. Stephen Karwaski1,
  10. Laurie Trussler1,
  11. Elizabeth Miller3,4,5,
  12. Tadeu Fantaneanu3,4,6,
  13. Parizad Varghaei3,6,
  14. Gregory Walker1,7,
  15. Howard Lesiuk1,2,3,4,
  16. Robert Fahed1,3,4,6
  1. 1Interventional Neuroradiology, Ottawa Hospital, Ottawa, Ontario, Canada
  2. 2Neurosurgery, Ottawa Hospital, Ottawa, Ontario, Canada
  3. 3Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
  4. 4Ottawa Hospital Research Institute (OHRI), Ottawa Hospital, Ottawa, Ontario, Canada
  5. 5Department of Anesthesia, Ottawa Hospital, Ottawa, Ontario, Canada
  6. 6Neurology, Ottawa Hospital, Ottawa, Ontario, Canada
  7. 7Department of Medicine – Division of Neurology, Royal Columbian Hospital, New Westminster, British Columbia, Canada
  1. Correspondence to Dr Robert Fahed, Medicine - Neurology, Ottawa Hospital, Ottawa, Ontario, Canada; robert.fahed{at}


Tandem occlusions, characterized by the simultaneous presence of an intracranial large vessel occlusion and extracranial carotid artery stenosis or occlusion,1 pose a unique endovascular challenge.2 3 Typically, the extracranial occlusion is a result of atherosclerotic plaque; however, dissections are also a possible cause. It is currently uncertain whether an intracranial first approach or an extracranial first approach should be employed.4 5 A new technique has been developed which allows for the simultaneous treatment of both the intracranial and the extracranial lesion.6 We describe a variation of this technique: the stent retriever for tandem acute revascularization technique (START), which consists of simultaneously treating the intracranial lesion with stent retriever and contact aspiration, and the extracranial lesion with balloon angioplasty. We present a technical video explaining all the steps of START.(video 1)

Video 1 Description and example of the START.

  • Stroke
  • Angioplasty
  • Thrombectomy
  • Technique

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  • AF and GZ are joint first authors.

  • Twitter @DanLaRussa

  • AF and GZ contributed equally.

  • Contributors All authors contributed significantly to this manuscript. The first two authors contributed equally to this manuscript and should be considered as co-first authors.

  • 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 Not commissioned; externally peer reviewed.

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