Urgent intracranial angioplasty after combined systemic and intra-arterial thrombolysis in acute stroke. An initial experience in indonesia.

SUMMARY: We report a case of a 59-year-old man who presented with an acute stroke involving the territory of his left middle cerebral artery, and who was treated with combined systemic and intraarterial thrombolysis. After these treatments, the segment remained stenotic. An urgent intracranial angioplasty was performed, resulting in satisfactory recanalization of the stenotic segment, and significant improvement of his National Institutes of Health Stroke Scale (NIHSS) from 14 to 5. This case report suggests an effective alternate protocol for treatment of acute stroke with arterial occlusion: immediate smaller dose of IV tissue plasminogen activator (tPA), followed by angiogram, intra-arterial thrombolysis, and angioplasty if indicated.