Case Report
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Clin Cases. Dec 16, 2013; 1(9): 290-294
Published online Dec 16, 2013. doi: 10.12998/wjcc.v1.i9.290
Tissue plasminogen activator via cross-collateralization for tandem internal carotid and middle cerebral artery occlusion
Ketan R Bulsara, Asiri Ediriwickrema, Joshua Pepper, Fergus Robertson, John Aruny, Joseph Schindler
Ketan R Bulsara, Joshua Pepper, Joseph Schindler, Neurosurgical Department, Yale and New Haven Hospital, New Haven, CT 06520, United States
Asiri Ediriwickrema, Yale University School of Medicine, New Haven, CT 06520, United States
Fergus Robertson, Interventional Radiology Department, National Hospital for Neurology and Neurosurgery, London, WC1N3BG, United Kingdom
John Aruny, Interventional Radiology Department, Yale and New Haven Hospital, New Haven, CT 06520, United States
Author contributions: All the authors contributed to the manuscript writing and revision.
Correspondence to: Ketan R Bulsara, MD, Director of Neuroendovascular and Skull Base Surgery, Neurosurgical Department, Yale and New Haven Hospital, 333 Cedar Street, TMP 4, New Haven, CT 06520, United States. ketan.bulsara@yale.edu
Telephone: +1-203-7372096 Fax: +1-203-7852044
Received: September 20, 2013
Revised: November 9, 2013
Accepted: December 9, 2013
Published online: December 16, 2013
Processing time: 88 Days and 7 Hours
Core Tip

Core tip: Tandem internal carotid artery and middle cerebral artery occlusions secondary to carotid artery dissections are refractory to stand alone medical management and often result in poor outcomes in patients receiving systemic tissue plasminogen activator (tPA). Cervical carotid stent assisted endovascular thrombolysis is effective, but carries the risk of worsening the dissection and propagating further thromboembolic events. Avoidance of carotid occlusions and recanalization with intra-arterial tPA using cross-collateralization, may be an effective, alternative treatment for patients with tandem internal carotid artery and middle cerebral artery occlusions.