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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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