PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY ADJUNCT TO THROMBOLYSIS FOR ACUTE MIDDLE CEREBRAL-ARTERY RETHROMBOSIS

PURPOSE: To report three patients, each of whom had acute rethrombosis of a reopened middle cerebral artery after urokinase treatment for pr oximal stenosis (percutaneous transluminal angioplasty of the stenosis was performed adjunctive to the thrombolytic treatment to preserve th e success of the thrombolysis), and a fourth patient who had percutane ous transluminal angioplasty right after the completion of thrombolysi s and had no rethrombosis despite a partial dilatation of the severe s tenosis. METHODS: Thrombolytic treatment was carried out by a coaxial technique with a Tracker 18 catheter through a 5-F angiographic cathet er; 80 000 U in 5 mL of urokinase were intermittently injected every 1 5 minutes after an initial dose of 250 000 U. All patients were given 3000 U of heparin with a booster dose of 1000 U every hour. Angioplast y was performed with a Stealth catheter balloon, 2 to 3 mm X 1.5 cm. R ESULTS: Three patients recovered without hemorrhage after percutaneous transluminal angioplasty and thrombolytic treatment. Percutaneous tra nsluminal angioplasty was unsuccessful in one patient because of the i nability to pass a 2-mm Stealth balloon catheter, and the result was a second rethrombosis. This patient had a poor recovery. CONCLUSION: Ac ute thrombosis of the middle cerebral artery may be associated with se vere proximal stenosis. Rethrombosis may occur even after complete thr ombolysis. Percutaneous transluminal angioplasty may be safely perform ed to prevent rethrombosis.