Spontaneous intracranial internal carotid artery dissection treated by intra-arterial thrombolysis and superficial temporal artery-middle cerebral artery anastomosis in the acute stage--case report--.
A 22-year-old man presented with sudden onset of right retro-orbital headache followed by left hemiparesis. Right carotid angiography demonstrated almost total occlusion of the intracranial internal carotid artery (ICA) and severe stenosis of the middle cerebral artery (MCA), presumably caused by arterial dissection. Local arterial injection of urokinase was performed 2 hours after onset. The ICA became patent, but the M2 portion of the MCA was still occluded, and the left hemiparesis did not improve. Superficial temporal artery-MCA anastomosis was immediately performed. The left hemiparesis disappeared completely 6 days after this procedure. Angiography 2 weeks after the onset revealed occlusion of the ICA, and maintenance of blood flow to the right cerebral hemisphere via the anastomosis. Magnetic resonance imaging showed small infarcts in the right cerebral cortex. Repeat angiography after 5 months showed recanalization of the right ICA and the right MCA. Combination of thrombolytic therapy and bypass surgery may be a useful treatment option for patients with sudden occlusion of the intracranial artery caused by dissection.
Ogiwara
Hideki
H
Department of Neurosurgery, Aizu Central Hospital, Aizuwakamatsu, Fukushima. ogiwara-h@genome.rcast.u-tokyo.ac.jp
Maeda
Keiichirou
K
Hara
Takayuki
T
Kimura
Toshikazu
T
Abe
Hajime
H
D000328:Adult; D001479:Basal Ganglia / Q000473:pathology / Q000503:physiopathology; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D020215:Carotid Artery, Internal, Dissection / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology; D005625:Frontal Lobe / Q000473:pathology / Q000503:physiopathology; D006261:Headache / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D020768:Middle Cerebral Artery / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery*; D019635:Neurosurgical Procedures; D010291:Paresis / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D013699:Temporal Arteries / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery*; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use; D014656:Vascular Surgical Procedures
D014568:Urokinase-Type Plasminogen Activator