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Images in Neurology
March 2013

Intra-arterial Thrombolysis of Acute Cerebral Vascular Occlusion During Endovascular Treatment of Adjacent Aneurysms at the Internal Carotid Artery

Author Affiliations

Author Affiliations: Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, China.

JAMA Neurol. 2013;70(3):406-407. doi:10.1001/jamaneurol.2013.602

A 44-year-old man presented with sudden onset of severe headache, and acute subarachnoid hemorrhage was confirmed by computed tomographic scan. His clinical status was Hunt and Hess grade II on hospital admission. Angiogram revealed dual adjacent but separate aneurysms originating from the paraclinoid segment of the right internal carotid artery. Under general anesthesia and systemic heparinization, endovascular coiling of 2 aneurysms was successfully carried out (Figure 1). However, control angiogram right after the coiling and removal of the microcatheter revealed complete occlusion of the middle cerebral artery (Figure 2A). Then the microcatheter was quickly navigated to the thrombus, and clot fragmentation and intra-arterial thrombolysis (IAT) with urokinase were started (Figure 2B). Final control angiogram showed near complete recanalization of the middle cerebral artery after infusion of 650 000 IU of urokinase (Figure 2B). The patient did not develop any neurological deficit after embolization and an antiplatelet agent was administered orally. Follow-up computed tomographic scan revealed no infarction or intracranial hemorrhage.

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