INTRAOPERATIVE HIGH-DOSE REGIONAL UROKINASE INFUSION FOR CEREBROVASCULAR OCCLUSION AFTER CAROTID ENDARTERECTOMY

Operative stroke complicating carotid endarterectomy is traditionally treated by reexploration of the operative site to correct a potentiall y causative Lesion; however, attempts are not made to diagnose or trea t the intracranial arterial occlusion. A 65-year-old man had a right h emiplegia during a left carotid endarterectomy that was caused by prem ature reversal of heparin, which resulted in thrombosis of his Left an terior cerebral artery. On reexploration, the patient was treated with a 1-hour infusion of I million U urokinase through an indwelling caro tid shunt, A repeat arteriogram demonstrated patency of the left anter ior cerebral artery, with complete clot dissolution and resolution of the right hemiplegia on awakening. Natural history studies of stroke a nd prospective, angiographically controlled clinical trials of intraar terial thrombolytic therapy for acute stroke support the use of intrao perative intraarterial infusion of urokinase as part of a therapeutic approach to patients who have an ischemic stroke during carotid endart erectomy.