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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 23:1596-1599, October 2002
© 2002 American Society of Neuroradiology

Case Report
INTERVENTIONAL

Complete Recovery after Early Intraarterial Recombinant Tissue Plasminogen Activator Thrombolysis of Carotid T Occlusion

Alejandro A. Rabinstein^a, Eelco F. M. Wijdicks^a and Douglas A. Nichols^b

^a Department of Neurology, Mayo Clinic, Rochester, MN
^b Department of Radiology, Mayo Clinic, Rochester, MN

Address reprint requests to E.F.M. Wijdicks, MD, Department of Neurology W8B, Mayo Clinic, 200 First Street SW, Rochester, MN 55905

Summary: Carotid T occlusion (intracranial carotid bifurcation occlusion with involvement of A1 and M1 segments) is associated with poor outcome. In most cases, treatment with intraarterial thrombolysis within a 6-hour window has been unsuccessful. We describe the case of a 26-year-old woman who presented with severe neurologic deficits (National Institutes of Health Stroke Scale score of 23) secondary to angiographically proved right carotid T occlusion. She was treated with intraarterial infusion of recombinant tissue plasminogen activator that was started less than 3 hours after symptom onset (26 mg administered during 2 hours 15 minutes). Thrombolysis resulted in recanalization of all major intracranial vessels and complete neurologic recovery. Early intraarterial thrombolysis may be effective in the treatment of patients with carotid T occlusion and should be considered for appropriate candidates.

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