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Combined therapeutic approach of intra-arterial thrombolysis and carotid endarterectomy in selected patients with acute thrombotic carotid occlusion 

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Presentation on theme: "Combined therapeutic approach of intra-arterial thrombolysis and carotid endarterectomy in selected patients with acute thrombotic carotid occlusion "— Presentation transcript:

1 Combined therapeutic approach of intra-arterial thrombolysis and carotid endarterectomy in selected patients with acute thrombotic carotid occlusion  Masaaki Uno, MDa, Fusamitsu Hamazaki, MDa, Takeshi Kohno, MDa, Akira Sebe, MDa, Hidehisa Horiguchi, a,b, Shinji Nagahiro, MDa  Journal of Vascular Surgery  Volume 34, Issue 3, Pages (September 2001) DOI: /mva Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

2 Fig. 1 Occlusion sites of internal carotid artery (ICAO ) and middle cerebral artery (MCAO ) and collateral flow in each of our four patients. Journal of Vascular Surgery  , DOI: ( /mva ) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

3 Fig. 2 Case 1. a, Initial CT scan showing no lesion. b, Initial cerebral angiogram showing ICA occlusion on right. c and d, Serial cerebral angiograms after intra-arterial thrombolysis showing partial recanalization of ICA and residual severe ICA stenosis. Note remaining middle cerebral artery occlusion on right. e, Serial CT scan after intra-arterial thrombolysis showing small infarction in right corona radiata. f and g, Follow-up angiogram after CEA showing good patency of ICA and MCA. Journal of Vascular Surgery  , DOI: ( /mva ) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

4 Fig. 3 Case 2. a, Initial CT scan showing old infarction on bilateral basal ganglia. b, Initial cerebral angiogram showing ICA occlusion on left side. c and d, Serial cerebral angiogram after intra-arterial thrombolysis showing partial recanalization of ICA and residual severe ICA stenosis. MCA was seen through ICA on left. e, Serial CT scan after intra-arterial thrombolysis indicating no new lesion. f and g, Follow-up angiogram after CEA showing good patency of ICA and MCA. Journal of Vascular Surgery  , DOI: ( /mva ) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

5 Fig. 4 Pathologic features, case 2. A, Carotid plaque removed by means of carotid endarterectomy shows intraplaque hemorrhage, ulcer, and luminal thrombus. B, Low-power view of atheromatous plaque showing rupture of fibrous cap (FC ) and intraplaque hemorrhage (PH ). C, High-power view of atheromatous plaque showing fibrin (F ) on surface of fibrous cap and red cell at plaque rupture point. LC, Lipid core. Journal of Vascular Surgery  , DOI: ( /mva ) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

6 Fig. 5 Case 3. a, CT scan obtained before initial angiography shows old infarction on left frontal lobe. b and c, Initial cerebral angiogram demonstrating ICA occlusion and collateral flow through ophthalmic artery on left side. d, Serial cerebral angiogram after intra-arterial thrombolysis showing partial recanalization of ICA and residual severe ICA stenosis. e, Serial CT scan after intra-arterial thrombolysis indicating no new lesion. f and g, Follow-up angiogram after CEA showing good patency of ICA and MCA. Journal of Vascular Surgery  , DOI: ( /mva ) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

7 Fig. 6 Case 4. a, Initial CT scan showing no lesions. b and c, Initial cerebral angiogram showing ICA occlusion and collateral flow through external carotid artery on left side. d and e, Serial cerebral angiogram after intra-arterial thrombolysis showing partial recanalization of ICA and residual severe ICA stenosis. MCA was seen through ICA on left. f, Serial CT scan after intra-arterial thrombolysis indicating small infarction on left putamen. g and h, Follow-up angiogram after CEA showing good patency of ICA and MCA. Journal of Vascular Surgery  , DOI: ( /mva ) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

8 Fig. 7 Pathologic features, case 4. A, Carotid plaque removed by means of CEA shows intraplaque hemorrhage, ulcer, and luminal thrombus. B, Low-power view of atheromatous plaque showing rupture of fibrous cap (FC ), luminal thrombus, and intraplaque hemorrhage. F, Fibrin. Journal of Vascular Surgery  , DOI: ( /mva ) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

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