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AJNR - American Journal of Neuroradiology

Published ahead of print on June 4, 2008
doi: 10.3174/ajnr.A1163

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Intra-Arterial Thrombolysis of Occluded Middle Cerebral Artery by Use of Collateral Pathways in Patients with Tandem Cervical Carotid Artery/Middle Cerebral Artery Occlusion

O. Ozdemir^a, M. Bussière^a,b, A. Leung^b, I. Gulka^b, D. Lee^b, R. Chan^a, J.D. Spence^a and D. Pelz^b

^a Department of Clinical Neurological Sciences, University of Western Ontario, London Health Sciences, University Campus, London, Ontario, Canada
^b Department of Diagnostic Radiology and Nuclear Medicine, University of Western Ontario, London Health Sciences, University Campus, London, Ontario, Canada

View larger version (53K): [in this window] [in a new window]   Fig 1. A, The right vertebral artery injection shows bilateral filling of the PcomA arteries that supply both internal carotid arteries. The left MCA M1 segment is occluded (small black arrow). B, Microcathether injection demonstrates a thrombus in the M1 segment (arrow) of the MCA. C, The right vertebral artery injection shows successful recanalization of the left MCA (arrow).

View larger version (43K): [in this window] [in a new window]   Fig 2. A, The left vertebral angiogram demonstrates an occlusion of the proximal MCA M1 segment (arrow). B, Administration of 15 mg of intra-arterial rtPA through a microcathether by use of the AcomA and PcomA arteries resulted in partial lysis of thrombus in the left M1 segment with restoration of flow within the inferior division of the left MCA. C, Follow-up CT angiogram 24 hours after stroke shows a complete recanalization of the M1 segment of the left MCA (arrow).