Is intravenous thrombolysis useful in carotid artery dissection with tandem occlusion?

Cervical artery dissection no longer represents an obstacle for performing intravenous (IV) thrombolysis. This treatment can be used safely for patients with cervical artery dissection, but tandem lesions may be related to poor outcome. We report a patient with an occlusive internal carotid artery (ICA) dissection and middle cerebral artery (MCA) embolus, with collateral circulation through the ophthalmic artery and communicating anterior artery. He underwent IV thrombolysis, with subsequent MCA recanalization and good outcome. In cases of tandem lesions in cervical artery dissection with MCA occlusion, IV thrombolysis is indicated despite the presence of ICA occlusion. Due to the presence of collateral circulation and the composition of the embolus, recanalization of MCA might be possible.