From Bad to Worse:  Intravenous Thrombolysis in Tandem Occlusion

Serdar Tütüncü; Annerose Ziegler; Jochen Fiebach; Heinrich Audebert; Christian Nolte

doi:10.4274/Tnd.77044

Serdar Tütüncü¹, Annerose Ziegler¹, Jochen Fiebach², Heinrich Audebert¹, Christian Nolte²

¹Charite Universtiy Hospital, Department Of Neurology, Berlin, Germany
²Center For Stroke Research - Charite, Berlin, Germany

Keywords: Stroke, tandem occlusion, iv thrombolysis

Abstract

We report a stroke patient with tandem occlusion of both the distal middle cerebral artery (MCA) and the ipsilateral internal carotid artery (ICA) who clinically deteriorated after intravenous thrombolysis in spite of recanalization of the ICA because of new proximal MCA (main-stem) occlusion. We discuss this unfortunate course (clinical deterioration in spite of partial recanalization) in the light of the characteristics of human brain vasculature and argue in favour of a more aggressive reperfusion strategy in this special setting.