|
FIG 2. Patient 8 with parossistic atrial fibrillation and acute onset of dysarthria, right hemiplegia and third cranial nerve palsy followed by loss of consciousness (NIHSS score=18).
The AP view of selective left vertebral artery injection (A) showed complete occlusion of the basilar artery. The left PCA completely filled through the posterior communicating artery during selective left internal carotid artery injection as observed in the LL view (B). Mechanical clot disruption (PTA) and as much as 1,000,000 IU of locally administered urokinase resulted in a complete recanalization of the basilar artery and its collaterals (C). Persistent embolic occlusion of the right P2–P3 segments of the PCA is also seen. The AP view of selective left vertebral artery injection obtained at the control DSA 24 hours later showed complete revascularization of the right PCA (D). Turbo spin-echo T2-weighted MR images in the sagittal plane 3 months later demonstrated a small cortical infarct in the left posterior and basal aspect of the temporal lobe with scattered ischemic spots in the brain stem and cerebellar hemispheres (E). The patient was discharged with a NIHSS score of 5 and at 3-month follow-up was able to conduct a completely independent lifestyle (mRS score=1).
|