Thrombolysis of the cervical internal carotid artery before balloon angioplasty and stent placement

Report of two cases

L. R. Guterman, J. L. Budny, K. J. Gibbons, L. N. Hopkins, S. L. Barnwell, A. Berenstein, R. H. Rosenwasser

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

THE APPLICATION OF endovascular techniques to the treatment of cervical carotid artery bifurcation atherosclerosis has been delayed because of the fear of causing embolic events while traversing the diseased portion of the artery with an angioplasty balloon catheter. Symptomatic carotid arteries often contain fresh or partially digested intraluminal thrombus. Before we cross certain carotid bifurcation lesions with angioplasty catheters, we deliver 100,000 to 200,000 units of urokinase in an attempt to digest loose thrombus. We have witnessed changes in the angiographic appearance of the diseased portion of the vessel after urokinase treatment, such as widening of the lumen, that suggest clot lysis. We present two patients who had symptomatic internal carotid artery stenosis. Angiography showed irregular narrowing of the internal carotid artery origin. One patient was selected for angioplasty instead of carotid endarterectomy because of severe cardiac risk factors. The other patient had major angiographic risk factors manifested by poor collateral circulation. The angiographic findings and history of transient ischemic attacks led us to suspect the presence of soft, loose plaque debris or thrombus in both cases. Therefore, we performed thrombolysis with urokinase before angioplasty. Repeat angiography showed widening of the arterial lumen and smoothing of the plaque profile. Subsequent angioplasty and stent placement were uneventful. Intraarterial thrombolysis can produce a change in the angiographic appearance of symptomatic atherosclerotic lesions of the cervical carotid artery bifurcation. Digestion of intralesional thrombus may provide a safer environment for deployment of endovascular remodeling devices by decreasing the likelihood of embolic phenomena. We believe thrombolysis should be done before angioplasty in select patients.

Original languageEnglish (US)
Pages (from-to)620-624
Number of pages5
JournalNeurosurgery
Volume38
Issue number3
DOIs
StatePublished - 1996
Externally publishedYes

Fingerprint

Balloon Angioplasty
Internal Carotid Artery
Angioplasty
Stents
Urokinase-Type Plasminogen Activator
Thrombosis
Carotid Arteries
Angiography
Catheters
Collateral Circulation
Endovascular Procedures
Carotid Endarterectomy
Carotid Stenosis
Transient Ischemic Attack
Fear
Digestion
Atherosclerosis
Arteries
Equipment and Supplies
Therapeutics

Keywords

  • Angiography
  • Angioplasty
  • Carotid atherosclerosis
  • Stent
  • Thrombolysis
  • Transient ischemic attacks

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Guterman, L. R., Budny, J. L., Gibbons, K. J., Hopkins, L. N., Barnwell, S. L., Berenstein, A., & Rosenwasser, R. H. (1996). Thrombolysis of the cervical internal carotid artery before balloon angioplasty and stent placement: Report of two cases. Neurosurgery, 38(3), 620-624. https://doi.org/10.1097/00006123-199603000-00053

Thrombolysis of the cervical internal carotid artery before balloon angioplasty and stent placement : Report of two cases. / Guterman, L. R.; Budny, J. L.; Gibbons, K. J.; Hopkins, L. N.; Barnwell, S. L.; Berenstein, A.; Rosenwasser, R. H.

In: Neurosurgery, Vol. 38, No. 3, 1996, p. 620-624.

Research output: Contribution to journalArticle

Guterman, LR, Budny, JL, Gibbons, KJ, Hopkins, LN, Barnwell, SL, Berenstein, A & Rosenwasser, RH 1996, 'Thrombolysis of the cervical internal carotid artery before balloon angioplasty and stent placement: Report of two cases', Neurosurgery, vol. 38, no. 3, pp. 620-624. https://doi.org/10.1097/00006123-199603000-00053
Guterman, L. R. ; Budny, J. L. ; Gibbons, K. J. ; Hopkins, L. N. ; Barnwell, S. L. ; Berenstein, A. ; Rosenwasser, R. H. / Thrombolysis of the cervical internal carotid artery before balloon angioplasty and stent placement : Report of two cases. In: Neurosurgery. 1996 ; Vol. 38, No. 3. pp. 620-624.
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