{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T21:46:42Z","timestamp":1775512002312,"version":"3.50.1"},"reference-count":8,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2012,3]]},"abstract":"<jats:p>Rapid revascularization of tandem extracranial and intracranial acute thromboembolic occlusions can be challenging and can delay restoration of blood flow to the cerebral circulation. Taking advantage of collateral pathways in the circle of Willis for thrombectomy can reduce the occlusion-to-revascularization time significantly, thereby protecting brain tissue from ischemic injury. The authors report using the trans\u2013anterior communicating artery (ACoA) approach by using the Penumbra microcatheter to rapidly restore blood flow to the middle cerebral artery (MCA) territory prior to treating the ipsilateral internal carotid artery (ICA) occlusion. Two patients with acute onset of tandem ipsilateral ICA and MCA occlusions and a competent ACoA underwent rapid revascularization of the MCA using a trans-ACoA approach for pharmaceutical and mechanical thrombolysis with the 0.026-in Penumbra microcatheter. Subsequently, once blood flow was reestablished in the MCA territory via cross-filling from the contralateral ICA, the proximally occluded ICA dissection was revascularized with a stent. Both patients had rapid revascularization of the MCA territory (both Thrombolysis in Myocardial Infarction Grade 3) with the trans-ACoA approach (19 and 36 minutes) followed by treatment of the ipsilateral proximal ICA occlusion. This prevented prolonged MCA ischemia time (72 and 47 minutes for ICA revascularization time saved) that would have otherwise occurred if the dissections were treated prior to revascularization of the MCA. Both patients had improved NIH Stroke Scale scores after the procedure. No adverse events from crossing the ACoA with the Penumbra microcatheter were encountered during the revascularization procedure. The trans-ACoA approach with the Penumbra microcatheter for rapid revascularization of an acutely thrombosed MCA in the setting of a simultaneous ipsilateral proximal ICA occlusion is feasible in patients with a competent ACoA. This technique can significantly minimize ischemic injury by reducing the occlusion-to-revascularization time and allow for MCA perfusion via collateral circulation while treating a proximal occlusion. To the best of the authors' knowledge, this is the first reported trans-ACoA approach with the Penumbra microcatheter and the first to report the utilization of the collateral intracranial circulation to reduce occlusion-to-revascularization time.<\/jats:p>","DOI":"10.3171\/2011.10.jns111516","type":"journal-article","created":{"date-parts":[[2011,12,23]],"date-time":"2011-12-23T15:11:40Z","timestamp":1324653100000},"page":"665-671","source":"Crossref","is-referenced-by-count":24,"title":["Tandem middle cerebral artery\u2013internal carotid artery occlusions: reduced occlusion-to-revascularization time using a trans\u2013anterior communicating artery approach with a Penumbra device"],"prefix":"10.3171","volume":"116","author":[{"given":"David J.","family":"Padalino","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric M.","family":"Deshaies","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-jns111516","series-title":"World Neurosurg","first-page":"17","article-title":"Posterior-to-anterior circulation access using the Penumbra Stroke System for mechanical thrombectomy of a right middle cerebral artery thrombus","volume":"73","author":"Hui","year":"2010"},{"key":"b2-jns111516","series-title":"Neurology","first-page":"1066","article-title":"Good clinical outcome after ischemic stroke with successful revascularization is time-dependent","volume":"73","author":"Khatri","year":"2009"},{"key":"b3-jns111516","series-title":"AJNR Am J Neuroradiol","first-page":"628","article-title":"Penumbra system: a novel mechanical thrombectomy device for large-vessel occlusions in acute stroke","volume":"31","author":"Kulcs\u00e1r","year":"2010"},{"key":"b4-jns111516","series-title":"Stroke","first-page":"2270","article-title":"Stent-assisted endovascular thrombolysis versus intravenous thrombolysis in internal carotid artery dissection with tandem internal carotid and middle cerebral artery occlusion","volume":"38","author":"Lavall\u00e9e","year":"2007"},{"key":"b5-jns111516","series-title":"Radiology","first-page":"614","article-title":"Patients with acute stroke treated with intravenous tPA 3\u20136 hours after stroke onset: correlations between MR angiography findings and perfusion- and diffusion-weighted imaging in the DEFUSE study","volume":"249","author":"Marks","year":"2008"},{"key":"b6-jns111516","series-title":"AJNR Am J Neuroradiol","first-page":"1596","article-title":"Intra-arterial thrombolysis of occluded middle cerebral artery by use of collateral pathways in patients with tandem cervical carotid artery\/middle cerebral artery occlusion","volume":"29","author":"Ozdemir","year":"2008"},{"key":"b7-jns111516","series-title":"Stroke","first-page":"2301","article-title":"Tandem internal carotid artery\/middle cerebral artery occlusion: an independent predictor of poor outcome after systemic thrombolysis","volume":"37","author":"Rubiera","year":"2006"},{"key":"b8-jns111516","series-title":"Stroke","first-page":"1616","article-title":"Clinical and tissue response to intravenous thrombolysis in tandem internal carotid artery\/middle cerebral artery occlusion: an MRI study","volume":"39","author":"Thomalla","year":"2008"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/116\/3\/article-p665.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/116\/3\/article-p665.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/116\/3\/article-p665.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T00:33:20Z","timestamp":1679877200000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/116\/3\/article-p665.xml"}},"subtitle":["Report of 2 cases"],"short-title":[],"issued":{"date-parts":[[2012,3]]},"references-count":8,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/2011.10.jns111516","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,3]]}}}