We greatly appreciate the comments by Calleja et al and Totah on our article.1 Calleja et al described a case with clinical fluctuations that was successfully treated by rtPA and suggested that recanalization of thrombus within the distal pial arteries may enhance pial collaterals and thereby stop stereotypical uncountable fluctuations. We agree with their hypothesis and their contribution to our discussion.
Ozdemir O, Beletsky V, Chan R, Hachinski V. Thrombolysis, Fluctuations, and Protocol Expansions—Reply. Arch Neurol. 2009;66(3):416-421. doi:10.1001/archneurol.2008.591