Recurrence of embolism post intravenous thrombolysis on an asymptomatic bilateral carotid stenosis
##plugins.themes.bootstrap3.article.main##
##plugins.themes.bootstrap3.article.sidebar##
Abstract
Atherosclerosis is the most common cause of stroke and patients with stroke due to large-vessel atherosclerosis are at the highest risk of recurrent stroke. Carotid endarterectomy (CEA) is a secondary prevention method for reducing the risk of stroke, but endovascular therapy has developed rapidly in recent years. The long-term therapeutic efficacy of endovascular stenting for carotid artery stenosis has been shown not to be inferior to CEA. We present the case of a 61-year-old female, smoker, dyslipidemic, hypertensive, therapeutically neglected, who suddenly developed right hemiplegia accompanied by central facial palsy and motor aphasia. The inclusion criteria allowed the initiation of intravenous thrombolytic therapy. At 2 and 24 hours after thrombolysis the evolution was favorable with the almost complete recovery of motor and speech production deficits. At 48 hours after thrombolysis, the patient experienced rapid decompensation and worsening, with recurrence of hemiplegia on the same side and motor aphasia. Cervical echoDoppler and cerebro-cervical CT angiography (CTA) revealed a complete right internal carotid artery (ICA) and quantified the degree of left ICA stenosis asymptomatic up to that time. The case was a challenge in terms of subsequent secondary prevention. Although most studies dealt with endarterectomy as a treatment for tight carotid stenosis, in the here reported case this was not possible, so we had to resort to angioplasty with placement of a self-expandable stent in the left ICA.
##plugins.themes.bootstrap3.article.details##
thrombolysis, asymptomatic stenosis, endarterectomy, self-expandable stent
2. Sallustio F, Koch G, Rocco A, et al. Safety of early carotid artery stenting after systemic thrombolysis: a single center experience. Stroke Res Treat 2012; 2012:904575.
3. Markus H, Pereira A, Cloud G. Secondary prevention of stroke. In Oxford Specialist Handbooks in Neurology-Stroke Medicine, Second Edition, Oxford University Press, 2017; (10):302-332.
4. Flumignan CDQ, Flumignan RLG, Navarro TP. Extracranial carotid stenosis: evidence based review. Rev Col Bras Cir 2017; 44(3):293-301.
5. Larry B. Goldstein modern medical management of acute ischemic stroke. Methodist Debakey Cardiovasc J 2014; 10(2):99-104.
6. Heo SH, Yoon KW, Woo SY, et al. Comparison of early outcomes and restenosis rate between carotid endarterectomy and carotid artery stenting using propensity score matching analysis. Eur J Vasc Endovasc Surg 2017; 54(5):573-578.
Archive of Clinical Cases is protected by copyright and may be used in accordance with copyright and other applicable laws. Content available at www.clinicalcases.eu and our digital applications is intended for personal noncommercial use.
Authors who submit a manuscript for publication in Archive of Clinical Cases agree to the following terms: a. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. b. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. c. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) only after the final version of the manuscript was accepted and published, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access). d. It is compulsory that before submission authors ensure that their work was not published in any other medical journals or pending acceptance for publication and that "Archives of Clinical Cases" is the only beneficiary at that moment if their work/case will be accepted by us.
Guidelines for linking to www.clinicalcases.eu a. The main purpose of the site linking to the Archive of Clinical Casess site should be educational. b. Links should be made to the Archive of Clinical Casess home page (www.clinicalcases.eu) or to the articles abstract. c. It is forbidden to use the Archive of Clinical Casess cover by outside organizations unless permission has been granted in advance, notifying our Secretary. d. Material owned by the Archive of Clinical Cases (including the name, logo, cover, and text) may not be used in any manner that may induce the idea or suggest that the Archive of Clinical Cases is in some way recommending a specific company, product or service. e. You must not use or allow others to access or use, all or any part of our Site or the contents and/or applications on it for commercial purposes without our permission. To seek permission to do anything prohibited by or not contained in these TERMS, or which requires our prior consent or agreement, you can contact us.