title: Intravenous thrombolysis, mechanical embolectomy, and intracranial stenting for hyperacute ischemic stroke in a patient with moyamoya disease.
abstract: The Japanese translation of moyamoya means "puff of smoke" and refers to the angiographic appearance of dilated collateral vessels seen during chronic progressive narrowing of the intracranial supraclinoid portions of the internal carotid arteries. Despite cerebral ischemia being the most common presenting symptom, 20% to 40% of adults suffer a hemorrhagic stroke. Due to the lack of evidence and histopathologic findings, intravenous and endovascular reperfusion therapy is typically avoided. This case study presents a patient with moyamoya disease in the hyperacute phase of ischemic stroke. The patient received full dose (0.9mg/kg) tissue plasminogen activator and subsequently underwent a mechanical clot extraction and Wingspan stent (Stryker, Kalamazoo, MI, USA) placement. The use of these options in the setting of moyamoya disease is novel. This demonstrates that moyamoya disease may not be an absolute contraindication to revascularization in hyperacute ischemic stroke and underscores that many perceived contraindications to thrombolytic and mechanical revascularization therapies are relative.
authors.affiliation: Bronson Neuroscience Center, Bronson Methodist Hospital, 601 John Street, Kalamazoo, MI 49007, USA. Electronic address: argedebo@bronsonhg.org.
authors.forename: Debora S
authors.initials: DS
authors.lastname: Argetsinger
authors.affiliation: Bronson Neuroscience Center, Director Neuroendovascular Surgery, Bronson Methodist Hospital, Kalamazoo, MI, USA.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Miller
authors.affiliation: Bronson Neuroscience Center, Bronson Methodist Hospital, 601 John Street, Kalamazoo, MI 49007, USA; Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Fletcher
mesh_terms: D061605:Administration, Intravenous; D002545:Brain Ischemia / Q000209:etiology / Q000628:therapy; D002548:Cerebral Revascularization / Q000379:methods*; D017128:Embolectomy / Q000379:methods; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D009072:Moyamoya Disease / Q000150:complications* / Q000601:surgery*; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000628:therapy; D015912:Thrombolytic Therapy / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; C067262:PLAT protein, human; D010959:Tissue Plasminogen Activator
keywords: Embolectomy; IV-tPA; Ischemic stroke; Moyamoya disease; Stent placement