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Intra-arterial thrombolytic therapy for hyperacute ischemic stroke caused by tandem occlusion

 Dong Joon Kim  ;  Dong Ik Kim  ;  Joon Soo Byun  ;  Jin Young Jung  ;  Sang Hyun Suh  ;  Eung Yeop Kim  ;  Ji Hoe Heo 
 CEREBROVASCULAR DISEASES, Vol.26(2) : 184-189, 2008 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Angiography, Digital Subtraction ; Brain Ischemia/complications ; Brain Ischemia/diagnostic imaging ; Brain Ischemia/drug therapy ; Brain Ischemia/etiology* ; Brain Ischemia/physiopathology ; Carotid Stenosis/complications* ; Carotid Stenosis/diagnostic imaging ; Carotid Stenosis/drug therapy ; Carotid Stenosis/physiopathology ; Cerebral Angiography ; Cerebrovascular Circulation/drug effects ; Collateral Circulation ; Feasibility Studies ; Female ; Fibrinolytic Agents/administration & dosage* ; Humans ; Infarction, Middle Cerebral Artery/complications* ; Infarction, Middle Cerebral Artery/diagnostic imaging ; Infarction, Middle Cerebral Artery/drug therapy ; Infarction, Middle Cerebral Artery/physiopathology ; Infusions, Intra-Arterial ; Male ; Middle Aged ; Stroke/diagnostic imaging ; Stroke/drug therapy* ; Stroke/etiology ; Stroke/physiopathology ; Thrombolytic Therapy* ; Treatment Outcome ; Urokinase-Type Plasminogen Activator/administration & dosage*
Thrombolysis ; Cerebral ischemia ; Collateral circulation
BACKGROUND: Tandem occlusion of the arteries at the extracranial and intracranial segments is a unique cause of ischemic stroke and is often associated with a poor prognosis. Although tandem occlusion is occasionally found during intra-arterial thrombolysis (IAT), as of yet no clear therapeutic strategy has been elucidated. METHODS: After identifying distal intradural (DIL) and proximal extradural lesions (PEL) as well as the collateral state and clot burden, IAT was performed primarily targeting DIL by navigation of the microcatheter through the PEL or a collateral pathway. RESULTS: Among 147 consecutive patients who were treated with IAT for hyperacute ischemic stroke, 13 (11.4%) were identified to have tandem occlusion as the cause of stroke. Navigation of a microcatheter through occluded PEL (internal carotid artery/vertebral artery) or a collateral pathway (anterior communicating artery) to the DIL was successful in 9 patients. Of them, recanalization of the DIL could be achieved in 8 (89%). The overall recanalization rate among all patients with tandem occlusion was (62%, 8/13). A good functional outcome (modified Rankin score <or=2) at 3 months was noted in 6 patients (46.2%). CONCLUSIONS: Tandem occlusion may be successfully managed by strategic thrombolysis of the DIL as the primary therapeutic target for IAT. By this strategy, the ischemic brain could be effectively and rapidly perfused.
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1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Ik(김동익)
Kim, Dong Joon(김동준) ORCID logo https://orcid.org/0000-0002-7035-087X
Kim, Eung Yeop(김응엽)
Byun, Joon Soo(변준수)
Suh, Sang Hyun(서상현) ORCID logo https://orcid.org/0000-0002-7098-4901
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
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