To Stent or Not to Stent: A Tale of Two Occlusions
| Autor: | Kennith F. Layton, Umair Khan, Steven Vayalumkal, Lyndon K Lee, Phu Nguyen, Tijani Osumah, Ali S Haider, Saira Alli, Aida Kafai Golahmadi, Richa Thakur |
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| Rok vydání: | 2017 |
| Předmět: |
acute ischemic stroke
thrombolysis medicine.medical_specialty medicine.medical_treatment Neurosurgery Balloon recanalization 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Angioplasty medicine.artery medicine cardiovascular diseases business.industry General Engineering angioplasty Stent Thrombolysis Surgery Neurology Adjunctive treatment Middle cerebral artery Internal carotid artery Carotid stenting business 030217 neurology & neurosurgery |
| Zdroj: | Cureus |
| ISSN: | 2168-8184 |
| DOI: | 10.7759/cureus.1364 |
| Popis: | Stenting and balloon angioplasty, along with mechanical thrombectomy, have gained notability as adjunctive treatment options to intravenous tissue plasminogen activator (IV-tPA) for tandem internal carotid artery (ICA) and middle cerebral artery (MCA) occlusions (TIM occlusions). Acute ischemic strokes (AISs) secondary to TIM occlusions are associated with poor patient outcomes primarily due to low recanalization rates following intravenous thrombolysis, consequently prompting the need for more invasive recanalization efforts. Often, the treatment algorithm is based on the success of the initial angioplasty, suspected volume of completed infarction, and whether or not thrombolytics are utilized. Here, we present two patients with AIS due to TIM occlusions where two different treatment modalities were implemented for recanalization efforts. Patient 1 did not receive IV-tPA and was successfully managed with balloon angioplasty and subsequent carotid stenting followed by direct oral anticoagulant (DOAC) administration. Patient 2 received IV-tPA and balloon angioplasty without carotid stenting followed by intracranial mechanical thrombectomy. Complete recanalization was attained in both cases. Administration of IV-tPA can make subsequent carotid stenting a potentially higher-risk treatment option for patients with TIM due to potential hemorrhagic complications in the setting of requisite antiplatelet agents. Each case of AIS resulting from a TIM must be considered unique, and the use of IV thrombolytics, balloon angioplasty, carotid stenting, and mechanical thrombectomy alone or in combination must be tailored to the individual clinical parameters. |
| Databáze: | OpenAIRE |
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