The paper presents the literature data concerning the results and surgical approaches to the treatment of tandem occlusion in the ICA system. The authors describe two clinical cases of endovascular treatment of tandem ipsilateral occlusion of ICA and middle cerebral artery (MCA). In both cases, the cause of two-level occlusion was complicated by thrombosis atherosclerotic plaque in ICA in the extracranial part with distal thromboembolism in SMA. The antegrade endovascular approach was used in both patients, when ICA was stented at the first stage, and at the second stage aspiration thrombectomy from SMA was performed. The period from the onset of symptoms to revascularization of the ICA system was 285±63 minutes. There were no fatal outcomes, patients were discharged with different neurological deficits: scores of the first patient were as following: 2 points on the NIHSS, 1 point on a Rankin scale, 13 points (initial 12 points on NIHSS) on the Rivermead mobility index and of the second patient: 14 points on the NIHSS, 5 points on a Rankin scale, 0 points (of the original 17 points on the NIHSS) on the Rivermead mobility index.