Patient 1: Clinical and radiological features. (A) Clinical course. (B) Thrombotic occlusion at internal carotid artery terminus. (C) Flow reestablished to MCA. (D) Reocclusion at origin of MCA (note: the unusual problem of 5 rapid rethromboses may have been related to heparin administration during the mechanical thrombectomies). (E) Flow reestablished to MCA and anterior cerebral artery (after infusion of tissue-plasminogen activator). No heparin exposure occurred as a result of the platelet transfusions (platelets were prepared using citrate anticoagulant). APTT, activated partial thromboplastin time; ASA, acetylsalicylic acid (aspirin); IU, international units; IV, intravenous; SC, subcutaneous; t-PA, tissue plasminogen activator; U, units; UFH, unfractionated heparin.