Aneurysms within large occluded target vessels can present significant challenges for neuro interventionists because rupture can be catastrophic. We recently encountered a case of left internal carotid artery–middle cerebral artery (MCA) ischemic stroke with an incidental MCA bifurcation aneurysm that we were already aware of. IV tissue plasminogen activator (tPA) with mechanical thrombectomy (MTE) was performed with a stent retriever, proximal to the aneurysm. TICI 2b recanalization was achieved. MTE and IV tPA may not be withheld from patients with acute stroke with known target vessel aneurysms.
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