title: Symbiotic relationship of IV-tPA and mechanical thrombectomy in a case of acute tandem ICA-MCA occlusion.
abstract: BACKGROUND
  In light of the recent successful mechanical thrombectomy trials, the need for IV-tPA prior is under investigation. Few cases demonstrate angiographically the role of both mechanical and chemical strategies at achieving reperfusion.
  
  
  METHODS
  A 63year-old male presented with an NIHSS 20. CTA demonstrated an acute occlusion of the left cervical and intracranial ICA and MCA. IV-tPA was administered, followed by immediate reperfusion of the cervical ICA with carotid stenting and mechanical thrombectomy. Within the next 10min, the entire intracranial clot burden dissolved under angiographic control. TICI 3 reperfusion was achieved without any further intervention. Post-procedure, the patient recovered fully to an NIHSS of 0.
  
  
  CONCLUSIONS
  This case underscores the importance of IV-tPA administration in conjunction to mechanical thrombectomy. The interventionalist should take advantage of the symbiotic effect of the IV-tPA administration, which remains the standard of care so far.
authors.affiliation: Duke University Hospitals, Department of Neurosurgery, Durham, NC, USA. Electronic address: maryih.cobb@duke.edu.
authors.forename: Mary In-Ping Huang
authors.initials: MI
authors.lastname: Cobb
authors.affiliation: Duke University Hospitals, Department of Emergency Medicine, Durham, NC, USA.
authors.forename: Derrick J
authors.initials: DJ
authors.lastname: Bruce
authors.affiliation: Duke University Hospitals, Department of Neurology, Durham, NC, USA.
authors.forename: Carmen
authors.initials: C
authors.lastname: Graffagnino
authors.affiliation: Duke University Hospitals, Department of Neurosurgery, Durham, NC, USA.
authors.forename: Erik F
authors.initials: EF
authors.lastname: Hauck
mesh_terms: D000208:Acute Disease; D003131:Combined Modality Therapy / Q000379:methods; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000628:therapy*; D007262:Infusions, Intravenous; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D061185:Mechanical Thrombolysis / Q000379:methods*; D008875:Middle Aged; D020521:Stroke / Q000000981:diagnostic imaging / Q000517:prevention & control; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator
keywords: Carotid stent angioplasty; Chemical thrombolysis; Ischemic stroke; Mechanical thrombectomy; Stroke intervention; Tandem occlusion