Intra-arterial thrombolysis in a patient presenting with an ischemic stroke due to spontaneous internal carotid artery dissection

We describe a case of a 38-year-old male who presented with acute onset of right-sided hemiplegia and aphasia, who was transferred for emergent percut aneous intervention, Angiography revealed a dissection with total occlusion of the left internal carotid artery (ICA) with propagation of thrombus in the distribution of the middle cerebral artery (MCA). Therapy was directed at the MCA and not the ICA. Intra-arterial thrombolysis was performed on th e M1 and M2 branches of the left middle cerebral artery, resulting in almos t complete resolution of symptoms during the angiography procedure, Heparin was continued postprocedure, and the patient was discharged home on warfar in and aspirin with minimal residual symptoms. Cathet. Cardiovasc. Interven t. 48:312-315, 1999. (C) 1999 Wiley Liss, Inc.