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Figure 6 Intracranial Local Thrombolysis After Iatrogenic Stroke
A 52-year-old man who had undergone a previous renal transplant and coronary artery bypass graft surgery presented with unstable angina. As the graft to the left anterior descending artery (LAD) was occluded, a proximal LAD lesion was stented. Heparin and eptifibatide were used as the antithrombotic and antiplatelet regimen. About 45 min after the procedure, the patient had right hemianopsia, and emergent intracerebral angiography was performed after a computerized tomography scan of the head excluded an intracranial hemorrhage. (A) Anterior circulation angiography: left common carotid angiography with intracranial imaging reveals patent anterior (AC) and middle cerebral (MC) arteries without significant disease of the intracranial internal carotid artery (IC). (B) Posterior circulation angiography: left vertebral angiography with intracranial imaging demonstrates left posterior cerebral artery (PCA) occlusion (arrow). (C) A Tracker catheter (Boston Scientific, Natick, Massachusetts) is placed beyond the occlusion in the left PCA via the vertebral artery approach, and contrast injection through the catheter confirms the patency of the distal vasculature. (D) After local delivery of intra-arterial thrombolytic therapy, flow is restored in the left PCA with the patient leaving the hospital with only a mild residual visual field cut. BA = basilar artery; VA = vertebral artery.
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