Intraoperative urokinase infusion for embolic stroke during carotid endarterectomy

Embolic stroke is an infrequent complication of carotid endarterectomy. Somatosensory evoked potential monitoring detected delayed acute neurological deterioration during endarterectomy performed on a 71-year-old woman. Intraoperative arteriography performed via an indwelling shunt revealed thrombus within the middle cerebral artery and distal branches. A microcatheter was placed into the internal carotid artery via the arteriotomy and advanced into the middle cerebral artery. Urokinase was infused into and around the thrombus until almost complete thrombolysis had been achieved. The patient recovered quickly and was discharged without neurological deficit.