Intravenous thrombolysis, mechanical embolectomy, and intracranial stenting for hyperacute ischemic stroke in a patient with moyamoya disease

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
Debora S ArgetsingerJeffrey J Fletcher

Abstract

The Japanese translation of moyamoya means "puff of smoke" and refers to the angiographic appearance of dilated collateral vessels seen during chronic progressive narrowing of the intracranial supraclinoid portions of the internal carotid arteries. Despite cerebral ischemia being the most common presenting symptom, 20% to 40% of adults suffer a hemorrhagic stroke. Due to the lack of evidence and histopathologic findings, intravenous and endovascular reperfusion therapy is typically avoided. This case study presents a patient with moyamoya disease in the hyperacute phase of ischemic stroke. The patient received full dose (0.9mg/kg) tissue plasminogen activator and subsequently underwent a mechanical clot extraction and Wingspan stent (Stryker, Kalamazoo, MI, USA) placement. The use of these options in the setting of moyamoya disease is novel. This demonstrates that moyamoya disease may not be an absolute contraindication to revascularization in hyperacute ischemic stroke and underscores that many perceived contraindications to thrombolytic and mechanical revascularization therapies are relative.

References

Mar 20, 2009·The New England Journal of Medicine·R Michael Scott, Edward R Smith
Jul 27, 2012·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Shota YokoyamaKoji Abe
Oct 17, 2012·The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques·Hye Mi LeeSang il Suh
Jan 24, 2015·Stroke; a Journal of Cerebral Circulation·Michael J RivkinCatherine Amlie-Lefond

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Citations

May 11, 2021·Developmental Medicine and Child Neurology·Emily BlackburnVijeya Ganesan
Aug 28, 2021·Journal of Clinical Medicine·Isabella CanaveroAnna Bersano

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