title: Importance of perioperative management for emergency carotid artery stenting within 24h after intravenous thrombolysis for acute ischemic stroke: Case report.
abstract: BACKGROUND
  We report a patient treated successfully via endovascular surgery within 24h after intravenous thrombolysis using recombinant tissue plasminogen activator for acute cervical internal carotid artery occlusion.
  
  
  METHODS
  A 68-year-old man was admitted to our hospital. Neurological examination revealed severe left-sided motor weakness. Magnetic resonance imaging showed no cerebral infarction, but magnetic resonance angiography revealed complete occlusion of the right internal carotid artery. Systemic intravenous injection of recombinant tissue plasminogen activator was performed within 4h after the onset. But, magnetic resonance angiography still revealed complete occlusion. Revascularization of the right cervical internal carotid artery was performed via endovascular surgery. The occluded artery was successfully recanalized using the Penumbra System(®) and stent placement at the origin of the internal carotid artery. Immediately after surgery, dual antiplatelet therapy (aspirin and clopidogrel) was initiated, and then cilostazol was added on the following day. Carotid ultrasonography and three-dimensional computed tomographic angiography at 14days revealed no further obstruction to flow.
  
  
  CONCLUSIONS
  When trying to perform emergency carotid artery stenting within 24h after intravenous recombinant tissue plasminogen activator administration, several issues require attention, such as the decisions regarding the type of stent and embolic protection device, the selection of antiplatelet therapy and the methods of preventing hyperperfusion syndrome.
  
  
  CONCLUSIONS
  Emergency carotid artery stenting for the acute internal carotid artery occlusion may be considered a safe procedure in preventing early stroke recurrence in selected patients.
authors.affiliation: Departments of Neurosurgery, Ehime Prefectural Central Hospital, Japan. Electronic address: iakihiro3@gmail.com.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Inoue
authors.affiliation: Departments of Neurosurgery, Ehime Prefectural Central Hospital, Japan.
authors.forename: Kanehisa
authors.initials: K
authors.lastname: Kohno
authors.affiliation: Departments of Neurosurgery, Ehime Prefectural Central Hospital, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Fukumoto
authors.affiliation: Departments of Neurosurgery, Ehime Prefectural Central Hospital, Japan.
authors.forename: Saya
authors.initials: S
authors.lastname: Ozaki
authors.affiliation: Departments of Neurology, Ehime Prefectural Central Hospital, Japan.
authors.forename: Satoko
authors.initials: S
authors.lastname: Ninomiya
authors.affiliation: Departments of Neurology, Ehime Prefectural Central Hospital, Japan.
authors.forename: Hitomi
authors.initials: H
authors.lastname: Tomita
authors.affiliation: Departments of Neurology, Ehime Prefectural Central Hospital, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Kamogawa
authors.affiliation: Departments of Neurology, Ehime Prefectural Central Hospital, Japan.
authors.forename: Kensho
authors.initials: K
authors.lastname: Okamoto
authors.affiliation: Departments of Neurosurgery, Ehime Prefectural Central Hospital, Japan.
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Ichikawa
authors.affiliation: Departments of Neurosurgery, Ehime Prefectural Central Hospital, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Onoue
authors.affiliation: Departments of Neurosurgery, Ehime Prefectural Central Hospital, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Miyazaki
authors.affiliation: Departments of Neurology, Ehime Prefectural Central Hospital, Japan.
authors.forename: Bungo
authors.initials: B
authors.lastname: Okuda
authors.affiliation: Departments of Neurosurgery, Ehime Prefectural Central Hospital, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Iwata
keywords: Dexmedetomidine; Emergency carotid artery stenting; Hyperperfusion syndrome; Penumbra System; Recombinant tissue plasminogen activator; Subacute; Thrombosis