Successful Endovascular Mechanical Thrombolysis in a Patient with Hyperacute Tandem Occlusions of Middle Cerebral Artery and Extracranial Internal Carotid Artery.
10.5853/kjs.2011.13.3.147
- Author:
Dong Woo RYU
1
;
Si Baek LEE
;
Siryung HAN
;
Bum Soo KIM
;
Hyung Eun PARK
;
Dae Woong BAE
;
Jaseong KOO
Author Information
1. Department of Neurology, The Catholic University of Korea College of Medicine, Seoul, Korea. nrstroke@catholic.ac.kr
- Publication Type:Case Report
- Keywords:
Tandem occlusion;
Mechanical thrombolysis;
Cerebral infarction
- MeSH:
Angiography;
Angioplasty;
Brain;
Carotid Artery, Internal;
Cerebral Infarction;
Hemiplegia;
Humans;
Hypertension;
Infarction;
Mechanical Thrombolysis;
Middle Cerebral Artery;
Neurologic Examination;
Sleep Stages;
Stents;
Thrombolytic Therapy;
Tissue Plasminogen Activator
- From:Korean Journal of Stroke
2011;13(3):147-151
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Previous studies have shown that patients with tandem occlusions involving extracranial internal carotid artery (ICA) and middle cerebral artery (MCA) have lower likelihood of recanalization by standard intravenous thrombolytic therapy. A 70-years-old man with a history of hypertension was admitted because of left hemiplegia and drowsiness which developed 47 minutes ago. On neurologic examination, he was drowsy and showed neglect syndrome as well as left hemiplegia. Brain CT angiography showed tandem occlusions at right extracranial ICA and proximal MCA. The administration of intravenous (IV) tissue plasminogen activator (tPA) did not improve his symptoms. We performed angioplasty and stenting for proximal ICA occlusion followed by mechanical thrombolysis for MCA occlusion. After the endovascular treatment, the MCA was recanalized and the patient recovered to show only mild left side weakness. This case shows successful treatment of hyperacute ischemic infarction from tendem occlusion of right MCA and proximal ICA with endovascular treatment following IV tPA thrombolysis.
