Emergency carotid artery stenting within 24 hours after intravenous thrombolysis for acute ischemic stroke: A case report

Abstract

We report a case treated successfully by emergency carotid artery stenting (CAS) within 24 h after intravenous thrombolysis for acute ischemic stroke An 80-year-old man was admitted to our hospital with disturbance of consciousness. Neurological examination on admission revealed severe right-sided motor weakness and motor aphasia. Magnetic resonance (MR) imaging showed cerebral infarction in the territory of the perforating artery and cortical branch of the left middle cerebral artery (MCA). MR angiography (MRA) revealed occlusion of the bilateral cervical internal carotid arteries (ICAs). Systemic intravenous injection of recombinant tissue plasminogen activator (iv rt-PA) was therefore performed 2.5 h after onset Following iv rt-PA therapy, neurological symptoms improved for 1 h, but MRA and cerebral angiography revealed severe stenosis of the left cervical ICA, complete occlusion of the right cervical ICA and left MCA occlusion Revascularization of the left cervical ICA was then performed using endovascular surgery (percutaneous transluminal angioplasty and CAS) 3.5 h after iv rt-PA therapy Postoperative course was uneventful except for mild restlessness, and hyperperfusion syndrome (HPS) did not develop. Strict control of blood pressure under dexmedetomidine anesthesia allowed effective prevention of HPS. After 1 week, recanalization of the left MCA was recognized on MRA and 123I-IMP-single photon emission computed tomography The patient was discharged with no neurological deficit after 2 weeks.