Right Internal Carotid Artery Occlusion during Intravenous Thrombolysis for Left Middle Cerebral Artery Occlusion
Thrombolysis with recombinant tissue plasminogen activator is the only established treatment for acute ischemic stroke. Recurrent ischemic stroke involving an initially unaffected arterial territory during the course of thrombolysis has been reported but remains exceptionally rare. Here we report a...
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| Published in | Journal of stroke and cerebrovascular diseases Vol. 18; no. 1; pp. 74 - 77 |
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| Main Authors | , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Elsevier Inc
2009
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1052-3057 1532-8511 1532-8511 |
| DOI | 10.1016/j.jstrokecerebrovasdis.2008.08.007 |
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| Abstract | Thrombolysis with recombinant tissue plasminogen activator is the only established treatment for acute ischemic stroke. Recurrent ischemic stroke involving an initially unaffected arterial territory during the course of thrombolysis has been reported but remains exceptionally rare. Here we report a 75-year-old woman with acute left middle cerebral artery occlusion who developed right internal carotid artery occlusion during the last minutes of recombinant tissue plasminogen activator infusion. Although the transthoracic echocardiography did not reveal an intra-atrial thrombus, cardioembolism due to disintegration of a pre-existing thrombus was thought to be the underlying mechanism because the patient had atrial fibrillation. Arterial occlusion due to intraplaque hemorrhage and de novo thrombosis caused by thrombin-mediated platelet aggregation are also discussed as potential mechanisms of arterial occlusion. |
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| AbstractList | Thrombolysis with recombinant tissue plasminogen activator is the only established treatment for acute ischemic stroke. Recurrent ischemic stroke involving an initially unaffected arterial territory during the course of thrombolysis has been reported but remains exceptionally rare. Here we report a 75-year-old woman with acute left middle cerebral artery occlusion who developed right internal carotid artery occlusion during the last minutes of recombinant tissue plasminogen activator infusion. Although the transthoracic echocardiography did not reveal an intra-atrial thrombus, cardioembolism due to disintegration of a pre-existing thrombus was thought to be the underlying mechanism because the patient had atrial fibrillation. Arterial occlusion due to intraplaque hemorrhage and de novo thrombosis caused by thrombin-mediated platelet aggregation are also discussed as potential mechanisms of arterial occlusion.Thrombolysis with recombinant tissue plasminogen activator is the only established treatment for acute ischemic stroke. Recurrent ischemic stroke involving an initially unaffected arterial territory during the course of thrombolysis has been reported but remains exceptionally rare. Here we report a 75-year-old woman with acute left middle cerebral artery occlusion who developed right internal carotid artery occlusion during the last minutes of recombinant tissue plasminogen activator infusion. Although the transthoracic echocardiography did not reveal an intra-atrial thrombus, cardioembolism due to disintegration of a pre-existing thrombus was thought to be the underlying mechanism because the patient had atrial fibrillation. Arterial occlusion due to intraplaque hemorrhage and de novo thrombosis caused by thrombin-mediated platelet aggregation are also discussed as potential mechanisms of arterial occlusion. Thrombolysis with recombinant tissue plasminogen activator is the only established treatment for acute ischemic stroke. Recurrent ischemic stroke involving an initially unaffected arterial territory during the course of thrombolysis has been reported but remains exceptionally rare. Here we report a 75-year-old woman with acute left middle cerebral artery occlusion who developed right internal carotid artery occlusion during the last minutes of recombinant tissue plasminogen activator infusion. Although the transthoracic echocardiography did not reveal an intra-atrial thrombus, cardioembolism due to disintegration of a pre-existing thrombus was thought to be the underlying mechanism because the patient had atrial fibrillation. Arterial occlusion due to intraplaque hemorrhage and de novo thrombosis caused by thrombin-mediated platelet aggregation are also discussed as potential mechanisms of arterial occlusion. |
| Author | Yalcin-Cakmakli, Gul Akpinar, Erhan Topcuoglu, Mehmet Akif Dalkara, Turgay |
| Author_xml | – sequence: 1 givenname: Gul surname: Yalcin-Cakmakli fullname: Yalcin-Cakmakli, Gul organization: Hacettepe University, Faculty of Medicine, Department of Neurology, Ankara, Turkey – sequence: 2 givenname: Erhan surname: Akpinar fullname: Akpinar, Erhan organization: Hacettepe University, Faculty of Medicine, Department of Radiology, Ankara, Turkey – sequence: 3 givenname: Mehmet Akif surname: Topcuoglu fullname: Topcuoglu, Mehmet Akif email: mat@hacettepe.edu.tr organization: Hacettepe University, Faculty of Medicine, Department of Neurology, Ankara, Turkey – sequence: 4 givenname: Turgay surname: Dalkara fullname: Dalkara, Turgay organization: Hacettepe University, Faculty of Medicine, Department of Neurology, Ankara, Turkey |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/19110150$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_3171_CASE20175 crossref_primary_10_1016_j_inat_2019_100620 crossref_primary_10_1016_j_ajem_2012_10_032 crossref_primary_10_5853_jos_2013_15_3_182 crossref_primary_10_1097_MBC_0b013e32834d7cf5 crossref_primary_10_7888_juoeh_45_133 crossref_primary_10_1161_STROKEAHA_109_569459 crossref_primary_10_3934_math_2023757 crossref_primary_10_32818_reccmi_a4s1a2 crossref_primary_10_1016_j_ajem_2011_10_016 |
| Cites_doi | 10.1161/01.STR.0000241064.46659.69 10.1385/NCC:3:1:054 10.1046/j.1540-8175.2001.00527.x 10.1046/j.1468-1331.2001.00216.x 10.1161/CIRCULATIONAHA.105.597435 10.1161/01.STR.30.12.2598 10.1212/WNL.57.11.2122 10.1161/STROKEAHA.107.483131 10.1161/01.STR.28.6.1107 10.1136/emj.2004.022681 10.1161/01.STR.26.2.324 10.1136/bmj.299.6711.1310 10.1161/01.CIR.85.5.1706 10.1212/01.wnl.0000237320.18214.6c 10.1056/NEJM199512143332401 10.1161/01.STR.0000251800.01964.f6 10.1177/000331979404500611 10.1161/01.STR.30.10.2101 10.1186/1476-7120-3-14 |
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| SubjectTerms | acute stroke treatment Aged cardioembolism Cardiovascular Carotid Artery, Internal - pathology Carotid Stenosis - chemically induced Carotid Stenosis - etiology Carotid Stenosis - pathology Cerebral Angiography Diffusion Magnetic Resonance Imaging Embolism - complications Female Fibrinolytic Agents - administration & dosage Fibrinolytic Agents - adverse effects Heart Diseases - complications hemorrhagic transformation Humans Infarction, Middle Cerebral Artery - drug therapy Infarction, Middle Cerebral Artery - pathology Infusions, Intravenous Neurology Plasminogen activator Recombinant Proteins - administration & dosage Risk Factors Thrombolytic Therapy Tissue Plasminogen Activator - administration & dosage Tissue Plasminogen Activator - adverse effects Tomography, X-Ray Computed |
| Title | Right Internal Carotid Artery Occlusion during Intravenous Thrombolysis for Left Middle Cerebral Artery Occlusion |
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