抄録
This paper reports on a case of acute occlusion of the middle cerebral artery in which successful recanalization was achieved by intraarterial infusion of tPA with marked symptomatic improvement. The patient was a 45-year-old female with a history of mitral valve replacement. She suddenly developed left hemiplegia accompanied by dysarthria during daytime activities. An initial CT scan conducted one hour after the onset showed a small low density area in the right thalamus, which was not considered to have been newly formed after the symptom onset. Carotid angiography taken two and a half hours after the stroke manifested a complete occlusion in the M1 portion of the right middle cerebral artery. Then, a superselective catheter was immediately introduced into the middle cerebral artery and guided to the site of embolism for the intraarterial infusion of tPA (300×104IU). Complete recanalization was noted 60 minutes later. The left hemiplegia and dysarthria diminished and finally disappeared several hours after the tPA infusion. This paper discusses the indications and procedures for intraarterial tPA infusion therapy, selectively reviewing the literature. The importance of combination therapy and correct posttreatment is emphasized.
