Tandem occlusion is a simultaneous occlusion of internal carotid and the average brain artery. It is a very serious radio-clinical entity with a bad vital and functional prognosis. The diagnosis is brought by medical imaging in the occurrence magnetic resonance angiography (MRA) and the angioscan of the supra-aortic trunks (SAT). The treatment is essentially endovascular in developed countries. On the other hand, in our environments where the technical plate is limited, the care is a big challenge. Thus we report two cases of tandem occasion confirmed respectively by magnetic resonance angiography (MRA) and Angioscan of SAT in order to evaluate the evolutionary profile of our patients under the drug treatment.