DR.MOHAMMED IRFAN SHEIKHover 4 years ago

Selective Intraarterial Thrombolysis for Cardioembolic Stroke

A 42-year-old woman with a history of exertional dyspnea, severe mitral stenosis (mitral valve area, 0.9 cm2) secondary to rheumatic heart disease, and atrial fibrillation was admitted for percutaneous mitral balloon valvotomy, to be performed with the MultiTrack (NuMED) single-wire, double-balloon device. After the patient underwent transseptal puncture during cardiac catheterization, consciousness became impaired, vertigo developed, and binocular visual loss occurred. We became concerned about a possible acute stroke, and cerebral angiography was performed, revealing total occlusion of the distal basilar artery, which suggested acute thrombosis (Panel A, arrow; Video 1). Selective intraarterial thrombolysis (Panel B, arrow; Video 2) was initiated 40 minutes after the ictus. Follow-up cerebral angiography was performed and showed resolution of the occlusion (Panel C, arrows; Video 3). Within 12 hours of the event, all neurologic abnormalities had resolved. The patient underwent mitral-valve replacement at a later date.