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[Intra-arterial thrombolysis of a basilar vascular accident during coronary angiography]
K Battikh1, R Rihani, J M Lemahieu
1Service de cardiologie de l'institut catholique de Lille.
Insights
A patient experienced a stroke after a procedure, but intra-arterial Urokinase successfully dissolved the basilar artery clot, leading to a full recovery. This case highlights a rare complication and effective treatment for cerebrovascular accidents.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Interventional Radiology
Background:
- A 67-year-old man with a history of aortobifemoral arterial graft developed unstable angina post-carotid endarterectomy.
- Coronary angiography via the right brachial artery led to a cerebrovascular accident (stroke).
Observation:
- The patient presented with coma, convulsions, and respiratory distress following angiography.
- Selective angiography revealed occlusive thrombosis of the basilar artery.
Findings:
- Immediate intra-arterial thrombolysis with Urokinase was administered.
- The thrombolysis successfully dissolved the clot, reestablishing flow in the basilar, cerebellar, and posterior cerebral arteries.
Implications:
- Cerebrovascular accident is a rare but serious complication of left heart catheterization.
- Prompt cerebral angiography and intra-arterial thrombolysis can lead to favorable outcomes in acute basilar artery thrombosis.
Abstract:
The authors report the case of a 67 year old man with a previous history of aortobifemoral arterial graft who had unstable angina after carotid endarterectomy. Coronary angiography by the right brachial artery was complicated by a cerebrovascular accident with a reactive coma, convulsions and respiratory problems. Selective angiography of the right vertebral artery showed an image of occlusive thrombosis of the basilar artery. In view of the clinical state and angiographic appearances, the authors decided on immediate intra-arterial thrombolysis with Urokinase which dissolved the clot and reestablished flow in the basilar artery, the cerebellar and posterior cerebral arteries. The outcome was favourable with immediate and good recovery of consciousness and hospital discharge on the sixth day without neurological or radiological sequellae. Cerebrovascular accident is a rare and potentially serious complication of left heart catheterisation which requires immediate cerebral angiography to determine the mechanism and propose an appropriate therapeutic approach.