Abstract
BackgroundThe treatment option for acute ischaemic stroke depends on the duration of symptoms, the dynamics of neurological condition changes, the aetiology, type of stroke, as well as the results of angiographic and neuroimaging tests.Case presentationA 60-year-old male patient presented with progressive left hemisphere stroke caused by extensive cardiogenic embolism of the common carotid artery and a thrombus closing the internal carotid artery from its ostium to the level of its intracranial division. The complex revascularisation therapy involving surgical embolectomy of the common carotid artery, thrombectomy of the internal carotid artery and intra-arterial thrombolysis has led to the improvement of arterial patency and has countered the progression of acute cerebral ischaemia.ConclusionEmergency carotid embolectomy together with thrombectomy and local thrombolytic rt-PA treatment may be a reasonable rescue therapy for carefully selected patients with large-vessel acute stroke. Further research is needed to establish the advantages and safety of surgical thrombectomy in patients with acute embolic occlusion of the carotid artery and ineffectiveness of or contraindications for systemic thrombolytic treatment.
Highlights
The treatment option for acute ischaemic stroke depends on the duration of symptoms, the dynamics of neurological condition changes, the aetiology, type of stroke, as well as the results of angiographic and neuroimaging tests.Case presentation: A 60-year-old male patient presented with progressive left hemisphere stroke caused by extensive cardiogenic embolism of the common carotid artery and a thrombus closing the internal carotid artery from its ostium to the level of its intracranial division
The application of thrombectomy and loco-regional thrombolytic treatment is recommended for a select cohort of patients who neither qualify for, nor benefit from, intravenous thrombolysis [1]
The treatment option for acute ischaemic stroke depends on the duration of symptoms, the dynamics of any neurological condition changes, the aetiology of the stroke, as well as the results of angiographic and neuroimaging tests
Summary
Emergency carotid embolectomy together with thrombectomy and local thrombolytic rt-PA treatment may be a reasonable rescue therapy for carefully selected patients with acute large-vessel stroke. Further trials are needed to establish the advantages and safety of surgical thrombectomy in patients with acute embolic occlusion of the carotid artery where systemic thrombolytic treatment is ineffective or contraindicated. DZ participated in its design and helped to draft the manuscript. Author details 1Department of Neurology, Medical University of Silesia Hospital No 7, Professor Leszek Giec Upper Silesian Medical Centre, Katowice, Poland. Papanagiotou P, Roth C, Walter S, Behnke S, Grunwald IQ, Viera J, et al Carotid artery stenting in acute stroke.
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