Emergent Double-barrel Bypass Shortly after Intravenous Administration of Recombinant Tissue Plasminogen Activator for Acute Ischemic Stroke.
10.7461/jcen.2016.18.3.258
- Author:
Joon Ho CHOI
1
;
Hyun Seok PARK
Author Information
1. Department of Neurosurgery, Busan-Ulsan Regional Cardio-Cerebrovascular Center, Medical Science Research Center, College of Medicine, Dong-A University, Busan, Korea. nsparkhs@dau.ac.kr
- Publication Type:Case Report
- Keywords:
Acute stroke;
Cerebral infarctions;
STA-MCA bypass;
Cerebral revascularization;
Tissue plasminogen activator;
Reperfusion
- MeSH:
Administration, Intravenous*;
Aged;
Carotid Artery, Internal;
Cerebral Arteries;
Cerebral Infarction;
Cerebral Revascularization;
Endarterectomy, Carotid;
Humans;
Magnetic Resonance Imaging;
Neurologic Manifestations;
Paresis;
Perfusion;
Reperfusion;
Stroke*;
Tissue Plasminogen Activator*
- From:Journal of Cerebrovascular and Endovascular Neurosurgery
2016;18(3):258-263
- CountryRepublic of Korea
- Language:English
-
Abstract:
Although intravenous recombinant tissue plasminogen activator (IV rt-PA) is effective in many cases of acute ischemic stroke, the neurologic symptoms can worsen after IV rt-PA because of sustained vessel occlusion. For such cases, several reperfusion modalities are available, including intra-arterial thrombolysis (IAT), carotid endarterectomy, and superficial temporal artery-middle cerebral artery (STA-MCA) bypass. Invasive procedures, such as major surgery, should be generally avoided within 24 hours after the administration of IV rt-PA. A 66-year-old man with no previous medical history developed left hemiparesis. A computed tomography scan revealed no acute lesion and he received IV rt-PA within 1.5 hours after symptom onset. Emergent magnetic resonance imaging showed significant diffusion-perfusion mismatch. He received IAT 2 hours after IV rt-PA administration, but IAT failed because of total occlusion of the cervical internal carotid artery. We initially planned to perform STA-MCA bypass the next morning because he had received IV rt-PA, but, 8 hours after IV rt-PA administration, his hemiparesis worsened from motor grade 3/4 to motor grade 1/2. Because of the large perfusion defect in both MCA divisions, double-barrel STA-MCA bypass was performed 10 hours after IV rt-PA administration. His symptoms rapidly improved after surgery and his modified Rankin Scale score 3 months later was grade 0. We suggest that emergent double-barrel bypass can be a viable option in patients who have perfusion defects of both MCA divisions in acute ischemic stroke after IV rt-PA administration.
