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AJNR - American Journal of Neuroradiology

Published ahead of print on September 26, 2007
doi: 10.3174/ajnr.A0702

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Anterior Cerebral Artery Emboli in Combined Intravenous and Intra-arterial rtPA Treatment of Acute Ischemic Stroke in the IMS I and II Trials

S. King^a, P. Khatri^a, J. Carrozella^a, J. Spilker^a, J. Broderick^a, M. Hill^a, T. Tomsick^a for the IMS & IIMS II Investigators

^a From the Clinical Coordinating Center, IMS Studies, University of Cincinnati, Cincinnati, Ohio

View larger version (134K): [in this window] [in a new window]   Fig 1. A, Pretreatment arteriogram with M1 occlusion and patent ACA. Baseline NIHSS 25. B, Control arteriogram after 45 minutes of IA treatment demonstrates A2 occlusion, with partial M1 recanalization. C, Final arteriogram after IA treatment demonstrates persistent occlusion of the distal left pericallosal artery superimposed on partial filling of the right ACA, complete recanalization of the M1 trunk with TICI 2 perfusion. D–F, A 24-hour CT demonstrates deep, insular, and inferior frontal infarct. MCA infarct extends superiorly (E) toward the distal posterior frontal lateral cortical borderzone and the distal ACA infarct (F).

View larger version (90K): [in this window] [in a new window]   Fig 2. Single 24-hour CT images from each of 8 subjects demonstrates ICA T occlusion with infarcts in the ACA distribution. Infarcts were all of small volume, located in the ACA cortical areas (A, B), cortical with subjacent white matter and internal borderzone areas (C–E), or in continuity with larger MCA infarct demonstration (F–H).