title: Successful management of post-tumor resection middle cerebral artery thrombosis with stent-assisted angioplasty and thrombolytic therapy: case report.
abstract: OBJECTIVE
  To describe successful endoluminal revascularization of an acute M1 occlusion 4 days after craniotomy and tumor resection.
  
  
  METHODS
  A 16-year-old right-handed girl presented with a 1-month history of daily headaches. The neurological examination was normal. Magnetic resonance imaging and computed tomography demonstrated a mass consistent with an epidermoid tumor compressing the left upper pons, left cerebral peduncle, and mesial left temporal lobe.
  
  
  METHODS
  A combination of low-dose antiplatelet agents administered intra-arterially and stent-assisted angioplasty was used. Successful endoluminal revascularization was achieved. Acute complications such as intracranial stent-thrombosis and/or intracranial hemorrhage were successfully avoided.
  
  
  CONCLUSIONS
  In the acute postoperative period, most current chemical thrombolytic protocols are contraindicated because of the prohibitive risk of iatrogenic intracranial hemorrhage. With an understanding of the pharmacokinetics of the currently available antiplatelet drugs, combined chemical and mechanical thrombolysis may be used in the acute postoperative setting for endoluminal recanalization.
authors.affiliation: Department of Neurosurgery, University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pennsylvania, USA.
authors.forename: Elad
authors.initials: E
authors.lastname: Levy
authors.forename: Michael
authors.initials: M
authors.lastname: Horowitz
authors.forename: Tudor
authors.initials: T
authors.lastname: Jovin
authors.forename: Amin
authors.initials: A
authors.lastname: Kassam
mesh_terms: D000293:Adolescent; D000800:Angioplasty, Balloon / Q000379:methods; D001932:Brain Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D020768:Middle Cerebral Artery / Q000473:pathology / Q000601:surgery; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D015607:Stents; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency