Combined Direct Percutaneous Transluminal Angioplasty and Low-Dose Native Tissue Plasminogen Activator Therapy for Acute Embolic Middle Cerebral Artery Trunk Occlusion
Takumi Yoneyamaa,
Shinichi Nakanob,
Hirokazu Kawanoa,
Tsutomu Isedab,
Tokuro Ikedaa,
Tomokazu Goyaa and
Shinichiro Wakisakab
a Department of Neurosurgery, Junwakai Memorial Hospital, Miyazaki, Japan
b Miyazaki Medical College, Miyazaki, Japan
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FIG 1. Case 4. A 74-year-old woman with aortic and mitral valve regurgitation who presented with sudden-onset consciousness disturbance and left complete hemiplegia.
A, Pre-PTA CT scan shows an old infarction in the right basal ganglia without any early CT ischemic changes.
B, Pre-PTA angiogram shows complete occlusion of right MCA trunk (arrow) and right ACA (arrowhead).
C, Angiogram obtained after PTA shows complete recanalization of the MCA trunk.
D, Angiogram obtained after PTA shows embolization in the small cortical arteries (arrows).
E, Follow-up CT scan shows no infarction in the cerebral cortex.
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