title: Tissue plasminogen activator via cross-collateralization for tandem internal carotid and middle cerebral artery occlusion.
abstract: Tandem internal carotid and middle cerebral artery occlusion after carotid dissection predicts poor outcome after systemic thrombolysis. Current treatments include the use of endovascular carotid stenting, which carries with it a high risk of propagating further embolic events and worsening the dissection. New strategies for avoiding the aforementioned side-effects include recanalization using cross-collaterals for delivery of intra-lesional tissue plasminogen activator (tPA). We present two cases that provide further support for this novel approach. Both patients presented with a National Institute of Health Stroke Scale of 20, received intra-arterial tPA via cross-collateralization, and made full recoveries without the need for stenting.
authors.affiliation: Ketan R Bulsara, Joshua Pepper, Joseph Schindler, Neurosurgical Department, Yale and New Haven Hospital, New Haven, CT 06520, United States.
authors.forename: Ketan R
authors.initials: KR
authors.lastname: Bulsara
authors.affiliation: Ketan R Bulsara, Joshua Pepper, Joseph Schindler, Neurosurgical Department, Yale and New Haven Hospital, New Haven, CT 06520, United States.
authors.forename: Asiri
authors.initials: A
authors.lastname: Ediriwickrema
authors.affiliation: Ketan R Bulsara, Joshua Pepper, Joseph Schindler, Neurosurgical Department, Yale and New Haven Hospital, New Haven, CT 06520, United States.
authors.forename: Joshua
authors.initials: J
authors.lastname: Pepper
authors.affiliation: Ketan R Bulsara, Joshua Pepper, Joseph Schindler, Neurosurgical Department, Yale and New Haven Hospital, New Haven, CT 06520, United States.
authors.forename: Fergus
authors.initials: F
authors.lastname: Robertson
authors.affiliation: Ketan R Bulsara, Joshua Pepper, Joseph Schindler, Neurosurgical Department, Yale and New Haven Hospital, New Haven, CT 06520, United States.
authors.forename: John
authors.initials: J
authors.lastname: Aruny
authors.affiliation: Ketan R Bulsara, Joshua Pepper, Joseph Schindler, Neurosurgical Department, Yale and New Haven Hospital, New Haven, CT 06520, United States.
authors.forename: Joseph
authors.initials: J
authors.lastname: Schindler
keywords: Carotid artery dissection; Intra-arterial tissue plasminogen activator; Tandem internal carotid artery and middle cerebral artery occlusion