Takeda Yasushi, Hashida Atsutomo, Futatsuya Koichiro, Takeshita Yohei, Ohta Hirotsugu, Yamamoto Junkoh
Department of Neurosurgery, MOJI Medical Center. Moji-ku, Kitakyushu 801-0853, Japan.
Department of Radiology, MOJI Medical Center. Moji-ku, Kitakyushu 801-0853, Japan.
J UOEH. 2023;45(2):133-139. doi: 10.7888/juoeh.45.133.
Early recurrent ischemic stroke (ERIS), as well as symptomatic intracranial hemorrhage (SICH) and progressive stroke (PS), causes early neurological deterioration. Here we report a case of a patient with right internal carotid artery (ICA) occlusion immediately after intravenous recombinant tissue plasminogen activator (rt-PA) treatment for left middle cerebral artery (MCA) occlusion. A 79-year-old woman with drowsiness, aphasia and right hemiparesis was brought to our hospital. MRI showed acute infarction in the left internal capsule and occlusion of the left middle cerebral artery. rt-PA was administered intravenously to the patient 2 hours after the onset of the event. Her consciousness disturbance and aphasia improved, but the right hemiparesis did not. We performed emergent endovascular thrombectomy, but the right ICA (cervical portion) was occluded during the surgery. Finally, the endovascular thrombectomy achieved the recanalization of the left MCA and right ICA. When performing intravenous thrombolysis, we should beware the possibility of re-occlusion and prepare for interventional treatment.
早期复发性缺血性卒中（ERIS）以及症状性颅内出血（SICH）和进展性卒中（PS）会导致早期神经功能恶化。在此，我们报告一例患者，在静脉注射重组组织型纤溶酶原激活剂（rt-PA）治疗左大脑中动脉（MCA）闭塞后立即出现右颈内动脉（ICA）闭塞。一名79岁女性，因嗜睡、失语和右侧偏瘫被送至我院。MRI显示左侧内囊急性梗死及左大脑中动脉闭塞。发病2小时后对该患者静脉注射rt-PA。她的意识障碍和失语有所改善，但右侧偏瘫未改善。我们进行了紧急血管内血栓切除术，但术中右颈内动脉（颈部）闭塞。最终，血管内血栓切除术实现了左大脑中动脉和右颈内动脉再通。在进行静脉溶栓时，我们应警惕再闭塞的可能性并为介入治疗做好准备。
