Background and Purpose: Cervicocephalic dolichoarteriopathy is not rare in patients with acute stroke. Results of intravenous (IV) tissue plasminogen activator (tPA) treatment have not been documented in this specific population. Methods: One hundred (58 females, age: 69 +/- 13 years) consecutive patients treated with IV tPA for acute anterior circulation stroke were analyzed. Smoker's criteria were used to score basilar artery dolichoarteriopathy and combined criteria of WeibelFields and Metz for cervical carotid artery dolichoarteriopathy. Results: Adjusted rates of effective response to tPA (defined as a decrease of the National Institutes of Health Stroke Scale [NIHSS] score to 1 or 0, or a total decrease >= 4 point by the end of the first 24 hours; in 51%); first-day dramatic response (>= 8 NIHSS score decrease; seen in 27%); 3-month favorable (modified Rankin score <= 2; in 46%) and excellent (modified Rankin score <= 1; in 37%) functional prognosis, and hemorrhagic complications (any hemorrhage in 34%, significant Fiorelli's parenchymal hemorrhage type 2 in 8%) of IV tPA were not modified with presence and categories of the basilar and extracranial carotid artery dolichoarteriopathy. Univariate analysis documented that basilar artery dolichoarteriopathy was significantly more prevalent in patients with effective response to IV tPA (22% versus 6%, odds ratio: 4.22, P =.041). However, an exploratory multiple regression analysis disclosed that NIHSS (per 1 point, beta = -. 256, P =.009) and time to needle (per 15-minutes, beta = -2.389, P =.019) were significant determiners of early favorable prognosis, whereas dolichoectasia was not (beta =.141, P =.159). Conclusion: IV tPA is safe and effective in acute anterior circulation stroke coexistent with intracranial posterior circulation dolichoarteriopathy and cervical carotid artery kinking, tortuosity, or coiling. (C) 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.