Good outcome case of anterior cerebral artery dissection that was treated with recombinant tissue plasminogen activator and trapping with A3-A3 anastomosis surgery

Sugimura, Yusuke; Koike, Kazunari; Terao, Satoshi; Asada, Hideo
September 2016
Neurology & Clinical Neuroscience;Sep2016, Vol. 4 Issue 5, p195
A 41-year-old Japanese man was diagnosed with acute ischemic stroke in the emergency room. He was given recombinant tissue plasminogen activator within a suitable time frame and symptoms were improved. However, follow-up magnetic resonance imaging showed asymptomatic expansion of the ischemic infarction, and 3-D computed tomography angiography showed the pearl and string sign of the left anterior cerebral artery. Then, trapping with A3-A3 anastomosis surgery was successfully carried out. This is a very rare case of a patient who was treated with recombinant tissue plasminogen activator and had a good outcome, and also had trapping with A3-A3 anastomosis surgery for an anterior cerebral artery dissecting aneurysm. However, because the pathology was determined to be dissection to the outer membrane, there was a risk of subarachnoid hemorrhage during the recombinant tissue plasminogen activator treatment. Cerebral arterial dissection is a disease that should not be forgotten, and that treatment is very difficult.


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