Combined therapeutic approach of intra-arterial thrombolysis and carotid endarterectomy in selected patients with acute thrombotic carotid occlusion.
OBJECTIVE
The feasibility and clinical outcome of intra-arterial thrombolysis followed by carotid endarterectomy (CEA) for acute thrombotic occlusion of the internal carotid artery (ICA) were evaluated.


METHODS
Intra-arterial thrombolysis and CEA were performed in four patients with acute thrombotic ICA occlusion. Computed tomography scans, cerebral angiograms, and the severity of carotid plaques were examined, and the patients' clinical outcome was evaluated.


RESULTS
All 4 patients had severe hemiparesis; 3 patients were alert, and 1 patient was lethargic at the time of hospital admission. New lesions were not shown by means of the initial computed tomography scan. ICA occlusion was indicated in all four patients by means of cerebral angiograms; in three patients, middle cerebral artery occlusion was noted. Collateral circulation was manifested in all patients. Partial recanalization of the occluded ICA was obtained in all patients. Two patients with severe residual ICA stenosis underwent an emergency CEA soon after thrombolysis; the other two patients were treated by means of CEA in the subacute or chromic stage. Plaque rupture and intraplaque hemorrhage were seen in all four patients. All four patients recovered completely, and restenosis of the ICA was not shown by means of follow-up angiograms.


CONCLUSIONS
Intra-arterial thrombolysis followed by CEA may be an effective therapeutic approach for treating acute thrombotic ICA occlusion. The optimal timing of CEA remains controversial.
Uno
M
M
Department of Neurological Surgery, School of Medicine, The University of Tokushima, Japan. neuros@clin.med.tokushima-u.ac.jp
Hamazaki
F
F
Kohno
T
T
Sebe
A
A
Horiguchi
H
H
Nagahiro
S
S
D000208:Acute Disease; D000368:Aged; D002341:Carotid Artery Thrombosis / Q000628:therapy*; D002343:Carotid Artery, Internal; D003131:Combined Modality Therapy; D016894:Endarterectomy, Carotid; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D012720:Severity of Illness Index; D015912:Thrombolytic Therapy