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Emergency carotid endarterectomy to reperfuse the poorly collateralized hemisphere and repair the ICA access site was performed 2 hours after completion of tissue plasminogen activator (tPA) infusion. This case illustrates the shortest reported interval between tPA infusion and open surgical intervention for carotid revascularization, as well as the role of direct carotid artery access for mechanical thrombectomy. The authors also describe the use of a temporizing femoral artery\u2013to\u2013ICA shunt to maintain cerebral perfusion in the setting of ICA occlusion.<\/jats:p>","DOI":"10.3171\/2017.6.jns162368","type":"journal-article","created":{"date-parts":[[2017,11,17]],"date-time":"2017-11-17T14:59:16Z","timestamp":1510930756000},"page":"718-722","source":"Crossref","is-referenced-by-count":11,"title":["Combined interventional and surgical treatment of tandem middle cerebral artery embolus and internal carotid artery occlusion: case report"],"prefix":"10.3171","volume":"129","author":[{"given":"Mark B.","family":"Frenkel","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaclyn J.","family":"Renfrow","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasmeet","family":"Singh","sequence":"additional","affiliation":[{"name":"Radiology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitin","family":"Garg","sequence":"additional","affiliation":[{"name":"Vascular and Endovascular Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacey Q.","family":"Wolfe","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1212\/WNL.53.1.122","article-title":"Antithrombotic treatment of ischemic stroke among patients with occlusion or severe stenosis of the internal carotid artery: A report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST)","volume":"53","author":"Adams HP Jr","year":"1999","unstructured":"Adams HP Jr, Bendixen BH, Leira E, Chang KC, Davis PH, Woolson RF, : Antithrombotic treatment of ischemic stroke among patients with occlusion or severe stenosis of the internal carotid artery: A report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST). 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