PMC3095941_01
Magnetic resonance imaging of the brain, (a) prethrombolysis diffusion-weighted image (DWI) shows brain infarct in the right MCA territory, (b) prethrombolysis Perfusion-weighted image (PWI) shows right brain hemisphere with perfusion defect, (c) prethrombolysis Magnetic resonance Angiography (MRA) shows absence of blood flow in the right MCA, (d) postthrombolysis DWI shows no significant interval changes in brain parenchyma, and (e) postthrombolysis MRA with patent right MCA.
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However, an MRI of the brain showed the right basal ganglia infarct with extensive perfusion defect in the right MCA territory (Figure 1) and no evidence of hemorrhagic transformation of infarct.
(a) Slow injection of dilute urokinase with microcatheter at site of occlusion; (b) recanalization of the right MCA with residual carotid stenosis.
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With the patient under conscious sedation and being monitored for neurological status, we slowly infused urokinase through a microcatheter at site of occlusion (Figure 2(a)). However, an underlying severe stenosis remained at the distal right ICA bifurcation (Figure 2(b)).
(a) Prestenting cerebral arteriography shows occluded terminal carotid artery; (b) Poststenting arteriography shows complete carotid recanalization.
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Florida) was successfully deployed at the stenotic segment of the right supraclinoid ICA bifurcation. Complete recanalization was achieved with the procedure, enabling an improvement in ICA luminal diameter from 1 mm to 2.5 mm as shown in Figure 3. Following the procedure, she was maintained on an antiplatelet regimen of clopidogrel and aspirin to maintain stent patency and measures  to  keep her systolic blood pressure below 140 mmHg to prevent hyperperfusion injury.