PMC5573111_01
Sequential on-table intraoperative angiograms. (A) Initial angiogram demonstrating occlusion of distal ICA. (B) Mid-procedural angiogram after commencing treatment with rt-PA. (C) Isolated ICA angiogram at end of treatment showing newly patent ICA. (D) Completion angiogram at end of treatment.
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The arteriotomy was closed and an on-table cerebral angiogram demonstrated complete occlusion of the left distal ICA and proximal middle cerebral artery (MCA) (Fig. 1A). A total of 35 mg of recombinant tissue plasminogen activator (rt-PA) was administered by the vascular surgeon via the catheter in 5 mg boluses every 10 minutes with repeated angiograms (Fig. 1B). The patient was assessed by the anaesthetist, who confirmed that the neurological status had returned to baseline (the patient remained under LA), and a completion angiogram demonstrated a fully patent ICA and MCA (Fig. 1C,D).