Successful Intra-Arterial Thrombolysis and Stenting in an Acute Ischemic Stroke Patient Caused by Anterior Cerebral Artery (ACA) Dissection with Occlusion
TL;DR: A case of anterior cerebral artery (ACA) dissection with occlusion causing cerebral infarction, and successfully cured by arterial thrombolysis and stenting is presented.
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Abstract: and Stenting in an Stroke Patient Caused by Abstract Ischemic stroke is a major cause of death and disability in China and worldwide. Many reasons can cause stroke, including atherosclerosis, artery embolization, and cervical artery dissection and so on. Among them, spontaneous intracerebral artery dissection is a rare cause of acute ischemic stroke. Here we present a case of anterior cerebral artery (ACA) dissection with occlusion causing cerebral infarction, and successfully cured by arterial thrombolysis and stenting. A 60-year-old man was admitted because of ischemic stroke. Imaging examination showed that the proximal A2 segment of the right ACA was occluded, suggesting an occlusive infarction of the right anterior cerebral artery. After emergency intravenous thrombolysis, the symptoms of patient were relieved, but the symptoms aggravated again one hour later. Emergency DSA was performed, and the symptoms were improved after arterial thrombolysis and stenting. After 10 days, CT showed that the right cerebral infarction area was slightly limited than before. 1 month later, the symptoms were significantly improved, the patient could walk independently, and was discharged 42 days after the onset of the disease.
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References
Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection
Stéphanie Debette,Stéphanie Debette,Annette Compter,M.-A. Labeyrie,Maarten Uyttenboogaart,T. M. Metso,Jennifer J. Majersik,Barbara Goeggel-Simonetti,Stefan T. Engelter,Alessandro Pezzini,Philippe Bijlenga,Andrew M. Southerland,Olivier Naggara,Yannick Béjot,John W. Cole,Anne Ducros,Giacomo Giacalone,Sabrina Schilling,Peggy Reiner,Hakan Sarikaya,Janna C Welleweerd,L. Jaap Kappelle,Gert J. de Borst,Leo H. Bonati,Simon Jung,Vincent Thijs,Juan Jose Martin,Tobias Brandt,Caspar Grond-Ginsbach,Manja Kloss,Tohru Mizutani,Kazuo Minematsu,James F. Meschia,Vitor Mendes Pereira,Anna Bersano,Emmanuel Touzé,Philippe Lyrer,Didier Leys,Hugues Chabriat,Hugh S. Markus,Bradford B. Worrall,Stéphane Chabrier,R W Baumgartner,Christian Stapf,Turgut Tatlisumak,Marcel Arnold,Marie-Germaine Bousser +46 more
TL;DR: Most patients with subarachnoid haemorrhage undergo surgical or endovascular treatment to prevent rebleeding, whereas patients with intracranial artery dissection and cerebral ischaemia are treated with antithrombotics.
Update on Treatment of Acute Ischemic Stroke.
Alejandro A. Rabinstein
- 01 Apr 2020
TL;DR: Timely successful reperfusion is the most effective treatment for patients with acute ischemic stroke and recent evidence supports the expansion of the time window for reperfusions treatment in carefully selected patients.
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Thrombolysis With Alteplase at 0.6 mg/kg for Stroke With Unknown Time of Onset: A Randomized Controlled Trial.
Masatoshi Koga,Haruko Yamamoto,Manabu Inoue,Koko Asakura,Junya Aoki,Toshimitsu Hamasaki,Takao Kanzawa,Rei Kondo,Masafumi Ohtaki,Ryo Itabashi,Kenji Kamiyama,Toru Iwama,Taizen Nakase,Yusuke Yakushiji,Shuichi Igarashi,Yoshinari Nagakane,Shunya Takizawa,Yasushi Okada,Ryosuke Doijiri,Akira Tsujino,Yasuhiro Ito,Hideyuki Ohnishi,Takeshi Inoue,Yasushi Takagi,Yasuhiro Hasegawa,Yoshiaki Shiokawa,Nobuyuki Sakai,Masato Osaki,Yoshikazu Uesaka,Shinichi Yoshimura,Takao Urabe,Toshihiro Ueda,Masafumi Ihara,Takanari Kitazono,Makoto Sasaki,Akira Oita,Sohei Yoshimura,Mayumi Fukuda-Doi,Kaori Miwa,Kazumi Kimura,Kazuo Minematsu,Kazunori Toyoda +41 more
TL;DR: No difference in favorable outcome was seen between alteplase and control groups among patients with ischemic stroke with unknown time of onset and the safety of altePlase at 0.6 mg/kg was comparable to that of standard treatment.
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Safety and Outcome of Carotid Dissection Stenting During the Treatment of Tandem Occlusions: A Pooled Analysis of TITAN and ETIS.
Gaultier Marnat,Bertrand Lapergue,Igor Sibon,Florent Gariel,Romain Bourcier,Maeva Kyheng,Julien Labreuche,Cyril Dargazanli,Arturo Consoli,Raphaël Blanc,Michel Piotin,Mikael Mazighi,Sébastien Richard,Sébastien Richard,Benjamin Gory,Etis Investigators +15 more
TL;DR: Emergency stenting of the dissected cervical carotid artery during endovascular therapy for tandem occlusions seems safe, whatever the quality of the intracranial reperfusion.
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Cerebral watershed infarcts may be induced by hemodynamic changes in blood flow.
Jingfei Shi,Ran Meng,Sanjay Konakondla,Yuchuan Ding,Yunxia Duan,Di Wu,Bincheng Wang,Yinghao Luo,Xunming Ji +8 more
TL;DR: Watershed infarcts were induced through changing hemodynamic conditions by bilateral CCA clamping in rats, and the majority of the ischemic lesions were located in watershed regions of the brain, demonstrated by both MRI and TTC staining.
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