scholarly journals Urgent Intracranial Angioplasty after Combined Systemic and Intra-Arterial Thrombolysis in Acute Stroke

2008 ◽  
Vol 14 (2_suppl) ◽  
pp. 91-94
Author(s):  
Cindy Sadikin ◽  
Agustinus Iskandar ◽  
Iswanto Pratanu ◽  
Hartono Yudi
Keyword(s):  
Case Report ◽  
Acute Stroke ◽  
Middle Cerebral Artery ◽  
Arterial Occlusion ◽  
National Institutes Of Health ◽  
Left Middle Cerebral Artery ◽  
Tissue Plasminogen ◽  
Left Middle ◽  
Stenotic Segment ◽  
Arterial Thrombolysis

We report a case of a 59-year-old man who presented with an acute stroke involving the territory of his left middle cerebral artery, and who was treated with combined systemic and intra-arterial thrombolysis. After these treatments, the segment remained stenotic. An urgent intracranial angioplasty was performed, resulting in satisfactory recanalization of the stenotic segment, and significant improvement of his National Institutes of Health Stroke Scale (NIHSS) from 14 to 5. This case report suggests an effective alternate protocol for treatment of acute stroke with arterial occlusion: immediate smaller dose of IV tissue plasminogen activator (tPA), followed by angiogram, intra-arterial thrombolysis, and angioplasty if indicated.

Bivalirudin for Endovascular Intervention in Acute Ischemic Stroke: Case Report

Neurosurgery ◽  
2004 ◽  
Vol 54 (1) ◽  
pp. 218-223 ◽  
Author(s):  
Mark R. Harrigan ◽  
Elad I. Levy ◽  
Bernard R. Bendok ◽  
L. Nelson Hopkins
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Scale Score ◽  
Intracranial Hemorrhage ◽  
National Institutes Of Health ◽  
Left Middle Cerebral Artery ◽  
Computed Tomographic ◽  
Left Middle ◽  
Arterial Thrombolysis

Abstract OBJECTIVE AND IMPORTANCE Intra-arterial thrombolysis has been demonstrated to improve recanalization and outcomes among patients with acute ischemic stroke. However, thrombolytic agents have limited effectiveness and are associated with a significant risk of bleeding. Bivalirudin is a direct thrombin inhibitor that has been demonstrated in the cardiology literature to have a more favorable efficacy and bleeding profile than other antithrombotic medications. We report the use of bivalirudin during endovascular treatment of acute stroke, when hemorrhagic complications are not uncommon. CLINICAL PRESENTATION A 71-year-old woman with atrial fibrillation presented with right hemiparesis and aphasia and was found to have a National Institutes of Health Stroke Scale score of 10. Computed tomographic scans revealed no evidence of intracranial hemorrhage, aneurysm, or ischemic stroke. Cerebral angiography revealed thromboembolic occlusion of the superior division of the left middle cerebral artery. INTERVENTION For anticoagulation, a loading dose of bivalirudin was intravenously administered before the interventional procedure, followed by continuous infusion. Attempts to remove the clot with an endovascular snare failed to induce recanalization of the vessel. Bivalirudin was then administered intra-arterially. Immediate postprocedural angiography demonstrated restoration of flow in the left middle cerebral artery. Repeat computed tomographic scans demonstrated no intracranial hemorrhage. The patient's hemiparesis and aphasia were nearly resolved and her National Institutes of Health Stroke Scale score was 2 at the time of her discharge 5 days later. CONCLUSION To our knowledge, this is the first report of the use of bivalirudin for treatment of acute ischemic stroke. Bivalirudin may be a useful agent for intravenous anticoagulation and intra-arterial thrombolysis in this setting.

scholarly journals Dyke-Davidoff-Masson syndrome: case report of fetal unilateral ventriculomegaly and hypoplastic left middle cerebral artery

2013 ◽  
Vol 39 (1) ◽  
pp. 32 ◽  
Author(s):  
Ettore Piro ◽  
Maria Piccione ◽  
Gianluca Marrone ◽  
Mario Giuffrè ◽  
Giovanni Corsello
Keyword(s):  
Case Report ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Left Middle Cerebral Artery ◽  
Left Middle

Abstract 1122‐000202: Two World Wars, Two Pandemics and Then Stroke:Thrombectomy, Angioplasty and Stenting in a 110‐Year‐Old Patient

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Pouria Moshayedi ◽  
Emily Chapman ◽  
Mais Al‐Kawaz ◽  
Jacopo Scaggiante ◽  
Halima Tabani ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Brain Mri ◽  
Temporal Cortex ◽  
Left Middle Cerebral Artery ◽  
Infarct Core ◽  
Vessel Occlusion ◽  
Stent Deployment ◽  
Left Middle

Introduction : Endovascular thrombectomy (EVT) is the standard of care in patients with acute stroke due to large vessel occlusion. In an aging population it is important to know EVT outcomes in old age, despite patients over 80 years are mostly excluded from major trial. While the oldest reported patients undergoing EVT was 102 years old, we report a 110 years old patient as the oldest patient undergoing EVT for stroke reported in the literature, and discuss the technical details and outcome. Methods : n/a Results : A 110‐ year‐old patient presented with right side weakness and slurred speech and found to have left middle cerebral artery occlusion. She received tenecteplase and transferred to angio‐suite 1 hour and 35 minutes after onset of symptoms. Left middle cerebral artery underwent two passes with stentriever, balloon angioplasty and stent deployment resulting in thrombolysis in cerebral infarction (TICI) 3 reperfusion. Brain MRI showed infarction in the left basal ganglia and left temporal cortex. After thrombectomy she was able to hold right arm and leg against gravity and follow commands. However, patient developed aspiration pneumonia and passed away after family chose to focus care on her comfort and refused tracheostomy and gastric tube. Conclusions : Despite poor clinical outcome, this case presents technical success in good recanalization, resulting in small infarct core and immediate neurological improvement in the oldest reported acute stroke patient undergoing thrombectomy.

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