AJDRAJNR - American Journal of Neuroradiology

Published ahead of print on November 16, 2007
doi: 10.3174/ajnr.A0825
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Impact of Arterial Reocclusion and Distal Fragmentation during Thrombolysis among Patients with Acute Ischemic Stroke

N. Janjuaa, A. Alkawib, M.F.K. Suric and A.I. Qureshic

a Department of Neurology, Long Island College Hospital and State University of New York Health Science Center at Brooklyn, Brooklyn, NY
b Department of Neurology and Neurosciences, University of Medicine and Dentistry of New Jersey, Newark, NJ
c Department of Neurology, the Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minn


Figure 1
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  		Fig 1. Arterial reocclusion. A 54-year-old woman, status post IV tissue plasminogen activator, has a left M1 occlusion seen in the anteroposterior (A) and lateral (B) planes (Qureshi grade 3A). After mechanical thrombolysis, there is improved flow in the superior division, frontal branches of M2 (arrows, C and D; Qureshi grade 2). However, the final angiogram shows reocclusion of the M1 stem similar to her initial angiographic appearance (E and F, Thrombolysis in Myocardial Infarction grade 0, Qureshi grade 3A).


Figure 2
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  		Fig 2. Distal embolization. A 53-year-old woman has right carotid terminus occlusion seen in the anteroposterior (panel A) and lateral (panel B) projections (Qureshi grade 5). Status post IA reteplase and intravenous abciximab, there is flow through the anterior cerebral artery seen in the anteroposterior (C) and lateral (D) projections. The arrow (D) indicates an occlusion of the callosomarginal branch, whereas the pericallosal branch is filling well (Qureshi grade 3B).





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