Clinical improvement with increased blood flow in the collateral pathway after intravenous rt-PA therapy

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  • ｒｔ－ＰＡ静注直後に側副血行路の血流改善によって臨床症状の改善を認めた脳梗塞の１例

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Abstract

A 65-year-old man showing total aphasia and right-sided hemiparesis was transferred to our hospital one hour after stroke onset. The National Institutes of Health Stroke Scale (NIHSS) score of the patient was 19 points and brain computed tomography (CT) did not reveal any hemorrhagic lesions or early CT signs. On emergency cerebral angiography, his left MCA was revealed to be completely occluded. We made a diagnosis of acute cerebral infarction, and the patient was administered intravenous rt-PA (recombinant tissue-type plasminogen activator) therapy at 150 min after the stroke onset. His serious symptoms improved gradually during the therapy from 30 min after rt-PA infusion, but his cerebral angiography after completing the therapy revealed continuous occlusion of the left MCA and increased collateral flow via cortical branches of the left anterior cerebral artery toward the territory of the left middle cerebral artery. On the third day after treatment, his symptoms improved except for the motor aphasia and right-sided hemiparesis. He was discharged with mild motor aphasia on the 26th day after treatment. Experience of this case suggests that the rapid clinical improvement by rt-PA therapy is a result not only of recanalization of culprit large arteries, but also of increasing collateral flow.

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