Case reportSymbiotic relationship of IV-tPA and mechanical thrombectomy in a case of acute tandem ICA-MCA occlusion

•Is IV-tPA still needed with emerging strength of mechanical thrombectomy?•We demonstrate a case of a 63 year-old male with a left ICA-MCA occlusion.•ICA re-perfused with carotid stent angioplasty and mechanical thrombectomy.•MCA occlusion dissolved with no further catheterization, TICI 3, NIHSS 0.•This underscores the symbiotic relationship of IV-tPA and mechanical thrombectomy.

Intro: In light of the recent successful mechanical thrombectomy trials, the need for IV-tPA prior is under investigation. Few cases demonstrate angiographically the role of both mechanical and chemical strategies at achieving reperfusion. Case report: A 63 year-old male presented with an NIHSS 20. CTA demonstrated an acute occlusion of the left cervical and intracranial ICA and MCA. IV-tPA was administered, followed by immediate reperfusion of the cervical ICA with carotid stenting and mechanical thrombectomy. Within the next 10 min, the entire intracranial clot burden dissolved under angiographic control. TICI 3 reperfusion was achieved without any further intervention. Post-procedure, the patient recovered fully to an NIHSS of 0. Conclusion: This case underscores the importance of IV-tPA administration in conjunction to mechanical thrombectomy. The interventionalist should take advantage of the symbiotic effect of the IV-tPA administration, which remains the standard of care so far.