Korean J Stroke.  2011 Dec;13(3):147-151. 10.5853/kjs.2011.13.3.147.

Successful Endovascular Mechanical Thrombolysis in a Patient with Hyperacute Tandem Occlusions of Middle Cerebral Artery and Extracranial Internal Carotid Artery

• Ryu DW
• Lee SB
• Han S
• Kim BS
• Park HE
• Bae DW
• Koo J

• KMID: 1996988
• DOI: http://doi.org/10.5853/kjs.2011.13.3.147

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.

Keyword

Tandem occlusion; Mechanical thrombolysis; Cerebral infarction

MeSH Terms

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
Tissue Plasminogen Activator