Stent-assisted endovascular thrombolysis versus intravenous thrombolysis in internal carotid artery dissection with tandem internal carotid and middle cerebral artery occlusion.
Stent-Assisted Endovascular Thrombolysis Versus Intravenous Thrombolysis in Internal Carotid Artery Dissection With Tandem Internal Carotid and Middle Cerebral Artery Occlusion To the Editor: We have read the exciting article entitled “Stent-assisted endovascular thrombolysis versus intravenous thrombolysis in internal carotid artery dissection with tandem internal carotid and middle cerebral artery occlusion.”1 The authors compared 4 patients who underwent intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator administered according to National Institute of Neurological Disorders and Stroke (NINDS) guidelines with 6 patients who were treated with an IV bolus of the glycoprotein (GP) IIb/IIIa antagonist abciximab (0.25 mg/kg body weight) and carotid stenting followed by mechanical thrombectomy in 5 cases and intra-arterial thrombolysis with 40 mg recombinant tissue plasminogen activator in the remaining case.1 Three-month outcome was worse in the IVT group although the presenting neurological deficit was comparable in the 2 groups and the mean time from stroke to treatment onset was 90 minutes longer in patients treated with endovascular techniques. These results differ from our findings observed in 18 consecutive patients with internal carotid artery dissection causing carotid occlusion and a symptomatic middle cerebral artery occlusion defined by a hyperdense middle cerebral artery sign in native brain CT in all cases, and in addition by catheter angiography in 4 and CT angiography in 6 cases (Table). Four patients were treated with carotid stenting followed by intra-arterial thrombolysis with urokinase (mean dose 625 000 227 000 IE; 3 patients have already been reported2), and 14 with IVT using recombinant tissue plasminogen activator according to the NINDS criteria. Severity of the baseline deficit was similar in both groups, and mean time from the onset of stroke to thrombolytic treatment was similar in both treatment