Selective Intra-arterial Thrombolysis for Embolic Complications of Cerebral Endovascular Therapy.

SUMMARY: Cerebral thrombo-embolic complications seldom occur during intracranial endovascular therapeutic procedures. Yet, despite a systemic preventive regimen of pre-operative intravenous acetylsalicylic acid and effective systemic heparinisation, we encountered seven complications of this type over a period of five years, a 3.7 per thousand incidence (7/1858). Local intra-arterial thrombolysis performed immediately after the thrombo-embolic complication resulted in complete recanalization in five cases and partial recanalization in two. CT scans performed 24 hours after thrombolysis were normal in six of the seven patients. Only one female patient with partial recanalization showed a limited cortical infarct in the parietal distribution of the middle cerebral artery territory. In all seven cases recanalization of the occluded vessel resulted in a return to the baseline initial neurological status. This short series demonstrates the usefulness of emergent thrombolysis dealing with the thrombo-embolic complications of angiography or endovascular therapy. These results are in agreement with these experimental data showing that early recanalization can prevent macroscopically visible infarcts.