Intracranial intraarterial thrombolysis facilitated by microcatheter navigation through an occluded cervical internal carotid artery

Journal of Neurosurgery
G M NesbitS L Barnwell

Abstract

This report covers a series of four patients with acute cervical carotid occlusion and profound neurological deficits who were treated with intracranial intraarterial thrombolysis. All of the patients presented with arm plegia with variable leg involvement and two of them had global aphasia. Angiography identified occlusion of the proximal internal carotid artery (ICA) in each case and intracranial thromboembolus of the supraclinoid ICA and/or its branches. Catheter navigation through the occluded ICA segment was straightforward in three patients and somewhat difficult in one patient with an 80% ICA stenosis. Intraarterial urokinase infusion along with mechanical clot disruption was performed at the clot site in the middle cerebral artery, supraclinoid ICA, and/or anterior cerebral artery. All patients had recanalization of the treated artery after urokinase infusion. Antegrade flow through the ICA was reestablished in two patients, and good collateral filling across the anterior communicating artery was established in the other two. All patients had major pretreatment deficits (mean National Institutes of Health (NIH) Stroke Score 24 +/-4) with significant improvement noted at 3 months posttreatment (NIH Stroke Score 7 +/-6;p=...Continue Reading

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Methods Mentioned

BETA
surgical bypass
dissection
coronary bypass

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