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Intra-arterial Thrombolysis of Embolic Middle Cerebral Artery Using Collateral Pathways

Published online by Cambridge University Press:  02 December 2014

Max K. Kole ,
David M. Pelz ,
Donald H. Lee ,
Vivek Jain ,
J. David Spence  and
Stephen P. Lownie
Max K. Kole
Affiliation:
Department of Clinical Neurological Sciences, University of Western Ontario, London Health Sciences Centre, University Campus, London, Ontario, Canada
David M. Pelz
Affiliation:
Department of Diagnostic Radiology and Nuclear Medicine, University of Western Ontario, London Health Sciences Centre, University Campus, London, Ontario, Canada
Donald H. Lee
Affiliation:
Department of Diagnostic Radiology and Nuclear Medicine, University of Western Ontario, London Health Sciences Centre, University Campus, London, Ontario, Canada
Vivek Jain
Affiliation:
Department of Clinical Neurological Sciences, University of Western Ontario, London Health Sciences Centre, University Campus, London, Ontario, Canada
J. David Spence
Affiliation:
Department of Clinical Neurological Sciences, University of Western Ontario, London Health Sciences Centre, University Campus, London, Ontario, Canada
Stephen P. Lownie
Affiliation:
Department of Clinical Neurological Sciences, University of Western Ontario, London Health Sciences Centre, University Campus, London, Ontario, Canada
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Abstract:

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Background and purpose:

Cervical internal carotid artery (ICA) occlusion associated with middle cerebral artery (MCA) embolic occlusion requires prompt revascularization to prevent devastating stroke. With the advent of endovascular techniques for chemical and mechanical thrombolysis, the clinical outcome of patients with major arterial occlusions will improve. Finding the most expedient pathway to the site of end organ occlusion for thrombolysis is important.

Methods:

We present two cases of acute stroke secondary to thrombotic occlusion of the cervical ICA associated with MCA embolic occlusion treated with intra-arterial thrombolysis via catheter navigation through the posterior communicating artery to the site of MCA arterial occlusion. No attempt was made to transverse the occluded ICA.

Results:

Near complete restoration of flow was achieved in one patient and minimal vessel reopening was observed in the other patient. Both patients had good outcomes.

Conclusion:

Intraarterial thrombolysis via Circle of Willis collaterals such as the posterior communicating artery for the treatment of acute thrombotic occlusion of the cervical internal carotid artery associated with embolic occlusion of the middle cerebral artery is a therapeutic option. This treatment option avoids the potential complications of navigating through an occluded proximal internal carotid artery and may expedite reopening of the MCA.

Résumé:

RÉSUMÉ:Introduction et but:

Il faut recourir rapidement à la revascularisation dans les cas d’occlusion de la carotide interne (CI) associée à l’occlusion embolique de l’artère cérébrale moyenne (ACM) pour éviter un accident vasculaire cérébral dévastateur. L’issue clinique des patients atteints d’occlusions artérielles majeures s’améliore depuis l’avènement des techniques endovasculaires de thrombolyse chimique et mécanique. Il est important de trouver la voie la plus avantageuse pour accéder au lieu de l’occlusion et procéder à la thrombolyse.

Méthodes:

Nous présentons deux cas d’accident vasculaire cérébral secondaire à une occlusion thrombotique de la CI associée à une occlusion embolique de l’ACM qui ont été traités par thrombolyse intra-artérielle, le cathéter ayant été guidé jusqu’au lieu de l’occlusion en passant par l’artère communicante postérieure. Il n’y a pas eu de tentative pour franchir l’occlusion sur la CI.

Résultats:

Le flot sanguin a été rétabli presque complètement chez un patient et de façon minimale chez l’autre. L’issue a été favorable chez les deux patients.

Conclusions:

La thrombolyse intraartérielle par les collatérales de l’hexagone de Willis, telle l’artère communicante postérieure, dans le traitement de l’occlusion thrombotique aiguë de la carotide interne associée à l’occlusion embolique de l’artère cérébrale moyenne est une option thérapeutique qui évite les complications potentielles liées au passage du cathéter par la carotid interne occluse et peut hâter l’ouverture de l’ACM.

Type
Case Reports
Information
Canadian Journal of Neurological Sciences , Volume 32 , Issue 2 , May 2005 , pp. 257 - 260
Copyright
Copyright © The Canadian Journal of Neurological 2005

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