title: Intra-arterial thrombolysis of embolic middle cerebral artery using collateral pathways.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  Intra-arterial 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.
authors: Department of Clinical Neurological Sciences, University of Western Ontario, London Health Sciences Centre, University Campus, London, Ontario, Canada.
authors: Max K
authors: MK
authors: Kole
authors: David M
authors: DM
authors: Pelz
authors: Donald H
authors: DH
authors: Lee
authors: Vivek
authors: V
authors: Jain
authors: J David
authors: JD
authors: Spence
authors: Stephen P
authors: SP
authors: Lownie
mesh_terms: D000368:Aged; D001488:Basilar Artery / Q000033:anatomy & histology / Q000502:physiology / Q000601:surgery; D001921:Brain / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D002341:Carotid Artery Thrombosis / Q000150:complications*; D002404:Catheterization / Q000592:standards; D002533:Cerebral Angiography; D002941:Circle of Willis / Q000033:anatomy & histology / Q000502:physiology / Q000601:surgery; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods*; D015912:Thrombolytic Therapy / Q000295:instrumentation / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D014711:Vertebral Artery / Q000033:anatomy & histology / Q000502:physiology / Q000601:surgery