title: Intra-arterial thrombolytic therapy for hyperacute ischemic stroke caused by tandem occlusion.
abstract: BACKGROUND
  Tandem occlusion of the arteries at the extracranial and intracranial segments is a unique cause of ischemic stroke and is often associated with a poor prognosis. Although tandem occlusion is occasionally found during intra-arterial thrombolysis (IAT), as of yet no clear therapeutic strategy has been elucidated.
  
  
  METHODS
  After identifying distal intradural (DIL) and proximal extradural lesions (PEL) as well as the collateral state and clot burden, IAT was performed primarily targeting DIL by navigation of the microcatheter through the PEL or a collateral pathway.
  
  
  RESULTS
  Among 147 consecutive patients who were treated with IAT for hyperacute ischemic stroke, 13 (11.4%) were identified to have tandem occlusion as the cause of stroke. Navigation of a microcatheter through occluded PEL (internal carotid artery/vertebral artery) or a collateral pathway (anterior communicating artery) to the DIL was successful in 9 patients. Of them, recanalization of the DIL could be achieved in 8 (89%). The overall recanalization rate among all patients with tandem occlusion was (62%, 8/13). A good functional outcome (modified Rankin score <or=2) at 3 months was noted in 6 patients (46.2%).
  
  
  CONCLUSIONS
  Tandem occlusion may be successfully managed by strategic thrombolysis of the DIL as the primary therapeutic target for IAT. By this strategy, the ischemic brain could be effectively and rapidly perfused.
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Yongdong Severance Hospital, Seoul, South Korea.
authors.forename: Dong Joon
authors.initials: DJ
authors.lastname: Kim
authors.forename: Dong Ik
authors.initials: DI
authors.lastname: Kim
authors.forename: Joon Soo
authors.initials: JS
authors.lastname: Byun
authors.forename: Jin Young
authors.initials: JY
authors.lastname: Jung
authors.forename: Sang Hyun
authors.initials: SH
authors.lastname: Suh
authors.forename: Eung Yeop
authors.initials: EY
authors.lastname: Kim
authors.forename: Ji Hoe
authors.initials: JH
authors.lastname: Heo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D016893:Carotid Stenosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation / Q000187:drug effects; D003097:Collateral Circulation; D005240:Feasibility Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage*
chemical_list: D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator