[Fibrinolytic treatment of acute ischemic accidents of the carotid artery].
The consequences of acute obstruction of the internal carotid artery or of its branches for the tissues depend on the efficiency of the mechanisms of hemodynamic and metabolic compensation of the cerebral blood flow. The occurrence of a neurologic deficit points out to insufficient compensation, but it does not allow assessing how irreversible the lesions are. The depth and duration of ischaemia are determining for the size of the residual infarct. Fast reperfusion of the ischaemic areas is aimed at limiting the size of the residual infarct but creates a risk of revascularization edema, and even of cerebromeningeal hemorrhage in case of ischaemic degradations of the blood-brain barrier. The indications of reperfusion are based on a pretherapeutic CT and angiographic assessment. The distal extension of thrombosis of the internal carotid artery as well as thrombosis or cruoric embolism of the carotid siphon or of the intracranial branches are not accessible to the conventional surgical reperfusion procedures but can be treated with local fibrinolytic infusion.
Maiza
D
D
Service de Chirurgie Thoracique et Cardio-Vasculaire, CHU Côte de Nacre, Caen.
Theron
J
J
D000208:Acute Disease; D000465:Algorithms; D002545:Brain Ischemia / Q000209:etiology / Q000517:prevention & control*; D002341:Carotid Artery Thrombosis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D002343:Carotid Artery, Internal; D006801:Humans; D015424:Reperfusion; D015912:Thrombolytic Therapy