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Is intravenous thrombolysis useful in carotid artery dissection with tandem occlusion?

Montserrat González Delgado1, Raquel García, Eduardo Murias

  • 1Neurology Service, Central University Hospital of Asturias, Oviedo, Spain. mglezdelgado@yahoo.es

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|September 21, 2010
PubMed

Insights

Intravenous thrombolysis is safe for cervical artery dissection patients. Even with tandem lesions, like internal carotid artery occlusion and middle cerebral artery embolus, this treatment can lead to successful recanalization and good outcomes.

Area of Science:

  • Neurology
  • Vascular Neurology
  • Interventional Neurology

Background:

  • Cervical artery dissection (CAD) is a significant cause of stroke in young adults.
  • Intravenous thrombolysis (IVT) has traditionally been a contraindication in CAD due to concerns about worsening dissection or hemorrhage.
  • Recent evidence suggests IVT may be safe and effective in select CAD cases.

Observation:

  • A case of a patient presenting with occlusive internal carotid artery (ICA) dissection and a concurrent middle cerebral artery (MCA) embolus is described.
  • The patient exhibited collateral circulation via the ophthalmic artery and anterior communicating artery.
  • The patient successfully underwent IV thrombolysis.

Findings:

  • Successful recanalization of the MCA was achieved following IV thrombolysis.
  • The patient experienced a good clinical outcome.
  • Tandem lesions in CAD, specifically ICA occlusion with MCA occlusion, do not preclude successful IVT.

Implications:

  • IV thrombolysis is a viable treatment option for acute ischemic stroke secondary to cervical artery dissection, even in the presence of tandem occlusions.
  • The presence of robust collateral circulation may predict successful recanalization in MCA emboli associated with CAD.
  • Further research is warranted to establish definitive guidelines for IVT in complex CAD presentations.

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