IV Thrombolysis-Bridging and Endovascular Treatment for Occlusive Internal Carotid Artery Dissection with Tandem Occlusion

• Main Authors: Filip Scheperjans, Johanna Pekkola, Satu Mustanoja, Jukka Putaala, Marjaana Tiainen, Leena Ollila, Tapio Paananen, Kimmo Lappalainen
• Format: Article
• Language: English
• Published: Karger Publishers 2012-01-01
• Series: Case Reports in Neurology
• Subjects: Carotid stenting; Thrombolysis; Ischemic stroke; Thrombectomy; Carotid artery dissection
• Online Access: http://www.karger.com/Article/FullText/335990

Compared to other etiologies of ischemic stroke, occlusive internal carotid artery dissection responds worse to intravenous (IV) thrombolysis. Intracranial tandem occlusion is a predictor of poor outcome. A direct endovascular approach has been proposed as a safe and probably superior alternative to IV thrombolysis. However, it may lead to considerable treatment delays. We used rapidly initiated IV thrombolysis-bridging and subsequent endovascular treatment in two patients with severe hemispheric ischemia due to occlusive internal carotid artery dissection with tandem occlusion and achieved good outcomes. Minimizing recanalization times likely improves patient outcome and IV thrombolysis-bridging may be a reasonable strategy to achieve this. The positive initial results obtained with endovascular approaches and IV thrombolysis-bridging in this patient group deserve further scientific exploration.