Abstract
We report a case of a patient who underwent a carotid endarterectomy for atheromatous pseudo-occlusion of the right internal carotid artery immediately after thrombolysis due to an intravenous injection of a recombinant tissue-type plasminogen activator (rt-PA, alteplase). A 75-year-old man was admitted to the emergency room of our hospital with unconsciousness and left hemiparesis. A computed tomography scan showed no signs of ischemia. Intravenous rt-PA therapy (348,000 IU/kg) was administered. He did not show significant improvement after administration, and a percutaneous transluminal angioplasty (PTA) was unsuccessfully performed. Immediately, a carotid endarterectomy (CEA) for atheromatous pseudo-occlusion of the right internal carotid artery was successfully performed. We conclude that emergent carotid endarterectomy can be a salvage therapy after rt-PA therapy is unsuccessfully performed.
