Primary angioplasty followed by chemical thrombolysis for carotid and middle cerebral artery occlusion (multimodality treatment)
- Department Of Neurology, Narayana Hrudayalaya Institute of Neurosciences, Narayana Health City, Bangalore
- Correspondence to Dr Vikram Huded, Consultant Interventional Neurologist, Department of Neurology, Narayana Hrudayalaya Institute of Neurosciences, Narayana Health City, Bangalore, Karnataka 560099, India; drvikramhuded{at}gmail.com
- Acute stroke
- primary angioplasty
- recombinant tissue plasminogen activator
- glycoprotein GP IIb/IIIa inhibitor
- stroke
- carotid artery disease
- thrombolysis
Introduction
Mortality rates associated with basilar artery occlusions, internal carotid artery ‘T’ occlusions and middle cerebral artery (MCA)–M1 segment occlusions are particularly high despite the best available medical therapy. The recanalisation rate of a patient with carotid T occlusion is 10%1 2 with intravenous thrombolysis and 33% with intra-arterial (IA) thrombolysis.3 We report a case of acute stroke in whom primary angioplasty of the left internal carotid artery followed by IA thrombolysis of MCA was done with a favourable outcome in our centre. This is the first reported case of such a procedure in India.
Case report
A 65-year-male subject who is a known diabetic and smoker presented with a history of blurring of vision of 6 h duration, followed by global aphasia and right sided hemiplegia of 2 h duration. The patient had global aphasia, gaze deviation to left side and right sided hemiplegia at admission. At presentation, National Institutes of Health Stroke Scale was 28. MRI brain showed restricted diffusion in basal ganglia, anterior cerebral artery/MCA and posterior cerebral artery/MCA watershed area (figure 1). Magnetic resonance angiogram showed complete occlusion …
