Complete recovery after early intraarterial recombinant tissue plasminogen activator thrombolysis of carotid T occlusion.
Carotid T occlusion (intracranial carotid bifurcation occlusion with involvement of A1 and M1 segments) is associated with poor outcome. In most cases, treatment with intraarterial thrombolysis within a 6-hour window has been unsuccessful. We describe the case of a 26-year-old woman who presented with severe neurologic deficits (National Institutes of Health Stroke Scale score of 23) secondary to angiographically proved right carotid T occlusion. She was treated with intraarterial infusion of recombinant tissue plasminogen activator that was started less than 3 hours after symptom onset (26 mg administered during 2 hours 15 minutes). Thrombolysis resulted in recanalization of all major intracranial vessels and complete neurologic recovery. Early intraarterial thrombolysis may be effective in the treatment of patients with carotid T occlusion and should be considered for appropriate candidates.
Rabinstein
Alejandro A
AA
Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Wijdicks
Eelco F M
EF
Nichols
Douglas A
DA
D000328:Adult; D015901:Angiography, Digital Subtraction; D001921:Brain / Q000473:pathology; D002341:Carotid Artery Thrombosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology; D002533:Cerebral Angiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008279:Magnetic Resonance Imaging; D015641:Radiography, Interventional; D011994:Recombinant Proteins / Q000627:therapeutic use*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator