Basilar artery occlusion in a child: 'clot angioplasty' followed by thrombolysis
| Autor: | Alain Weill, L Castaings, Jaques Moret, Christophe Cognard, Michel Piotin, Stig Lindgren |
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| Rok vydání: | 2000 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Cerebral arteries Arterial Occlusive Diseases Plasminogen Activators Angioplasty medicine.artery medicine Basilar artery Humans Thrombolytic Therapy Thrombus Child medicine.diagnostic_test business.industry Balloon catheter General Medicine Thrombolysis medicine.disease Thrombosis Magnetic Resonance Imaging Urokinase-Type Plasminogen Activator Surgery Cerebral Angiography Basilar Artery Pediatrics Perinatology and Child Health Angiography Acute Disease Neurology (clinical) business Tomography X-Ray Computed Angioplasty Balloon |
| Zdroj: | Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery. 16(8) |
| ISSN: | 0256-7040 |
| Popis: | Basilar artery occlusions are rare but have a very poor prognosis. Intra-arterial thrombolysis may produce recanalization and better clinical outcome. A short delay between the onset of symptoms and thrombolysis is considered essential for successful recanalization and for the smallest possible risk of haemorrhagic complications. We present a case of basilar artery occlusion in an 8-year-old child, which was treated by ”clot angioplasty” followed by intra-arterial thrombolysis. Thirty hours after progressive alteration of consciousness, speech disturbances and left arm paresis, the child became comatose with decerebrate rigidity. A CT scan showed parenchymal ischaemic lesions. Angiography (performed 36 h after the onset of symptoms) showed a total occlusion of the basilar artery. A clot angioplasty was performed by placing a balloon catheter within the thrombus and inflating it several times in the occluded segment of the basilar artery. Thrombolysis was then performed through the balloon catheter. The basilar artery was only partially recanalized at the end of the procedure, but the perforating arteries of the brain stem had reappeared on angiography. Three months later the child had completely recovered to a normal clinical status. In conclusion, the very poor natural prognosis of basilar artery occlusion requires aggressive management. Recanalization of the basilar artery may be performed even late after the onset of symptoms. Clot angioplasty allows partial recanalization, which may increase the efficiency of thrombolysis. |
| Databáze: | OpenAIRE |
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