Microcatheter Navigation and Thrombolysis in Acute Symptomatic Cervical Internal Carotid Occlusion
A. Srinivasana,
M. Goyala,
P. Stysb,
M. Sharmab and
C. Luma
a Department of Diagnostic Imaging, Division of Neuroradiology, University of Ottawa, Ottawa, Ontario, Canada
b Department of Medicine, Division of Neurology, University of Ottawa, Ottawa, Ontario, Canada
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Fig 1. A, Diagnostic angiogram of the left internal carotid artery (ICA) reveals good flow across the anterior communicating artery (AcomA) but poor filling of the right MCA territory because of a thrombus demonstrated on an earlier CT angiogram.
B, Successful recanalization of right MCA is seen after administration of 9 mg of tissue plasminogen activator (tPA) into the middle cerebral artery (MCA).
C, Diagnostic angiogram of the left ICA reveals cross-filling through the AcomA into the right MCA. There is probably dilution of contrast in the MCA by nonopacified blood from the ipsilateral posterior communicating artery because good patency of the MCA was demonstrated on the earlier microcatheter injection.
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Fig 2. A, Lateral angiogram of the left common carotid artery (CCA) in a 24-year-old man with acute left hemiplegia reveals a pseudoaneurysm (arrow) in the distal cervical internal carotid artery (ICA) with narrowing of the parent artery.
B, The right CCA angiogram shows complete occlusion of the right ICA (arrow) just beyond the bulb.
C, Microcatheter injection demonstrates a thrombus in the distal M1 segment (arrow) of the middle cerebral artery (MCA).
D, Administration of 7.5 mg of intra-arterial tissue plasminogen activator (IA tPA) through the microcatheter, which was advanced into the face of the thrombus, resulted in lysis of thrombus and restoration of antegrade flow.
E, Microcatheter injections demonstrate a pseudoaneurysm in the distal cervical right ICA (arrow).
F and G, Repeat angiogram through the guiding catheter after successful treatment by using 2 overlapping covered stents reveals no filling of the pseudoaneurysm and normal flow in the MCA. The patient recovered complete power on the left side within minutes of the procedure. The left ICA dissection and pseudoaneurysm were managed conservatively and, at 2 months after the procedure, the patient had no neurologic deficits.
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