Intra-arterial fibrinolysis via the contralateral internal carotid artery for acute ischemic stroke

We report a 65-year-old male who suddenly developed consciousness disturbance and left hemiplegia, with tandem embolic occlusions of the right internal carotid artery (ICA) and the middle cerebral artery (MCA). Intra-arterial administration of recombinant tissue plasminogen activator (rtPA) through the right ICA was performed 2.75 hours after onset, but no recanalization of the right ICA was obtained. Then rtPA was administrated from the left ICA, and the right MCA was recanalized 3 hours after onset. Our findings indicate that administration of rtPA through the contralateral internal carotid system could be an effective strategy for patients with tandem occlusions of the ICA and MCA if an anterior communicating artery is patent.