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Postoperative intracranial thrombolysis and angioplasty.
MedLine Citation:
PMID:  20663365     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
The case study involves a patient presenting middle cerebral artery thrombosis, related to a severe vasospasm following subarachnoid hemorrhage due to aneurysm rupture. The patient was treated initially by surgical clipping of the left middle cerebral artery aneurysm. After surgery, the neurological status of the patient was normal. Six days later, the patient presented right hemiplegia and aphasia that were related to the proximal left middle cerebral artery thrombosis. Despite recent open-skull surgery, in situ thrombolysis using urokinase and antip late let antibodies (abciximab) was performed. The thrombosed artery was reopened and a severe vasospasm was observed. The vasospasm was treated by transluminal angioplasty. No intracranial hemorrhage was noted after thrombolysis and angioplasty, whereas subcutaneous hemorrhage around the scalp incision was observed. The patient recovered from motor and language impairment. The only long-term symptom was a mild dysorthographia. Balance of risk/benefit is discussed for such aggressive thrombolytic therapy. In this particular case, effectiveness and uneventful use of abciximab was demonstrated despite very recent brain surgery that was considered a formal contra-indication for the use of such a powerful thrombolytic drug. Vessel thrombosis is an exceptional complication of cerebral vasospasm. In the early hours, intra-arterial thrombolysis may be considered, but recent intracranial surgery is usually an exclusion criterion to performing thrombolysis. We report the case of a patient who underwent thrombolysis and angioplasty in the postoperative period to treat this complication of vasospasm.
Authors:
O Levrier; J M Stordeur; N Bruder; L Manera; P Bouillot; C H Raybaud
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Publication Detail:
Type:  Journal Article     Date:  2002-01-10
Journal Detail:
Title:  Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences     Volume:  7     ISSN:  1591-0199     ISO Abbreviation:  Interv Neuroradiol     Publication Date:  2001 Dec 
Date Detail:
Created Date:  2010-07-28     Completed Date:  2012-10-02     Revised Date:  2014-07-30    
Medline Journal Info:
Nlm Unique ID:  9602695     Medline TA:  Interv Neuroradiol     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  325-30     Citation Subset:  -    
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