Intra-arterial thrombolytic therapy for acute anterior spinal artery stroke.

Spinal cord infarction is rare but can be extremely disabling. Prompt diagnosis and treatment of these infarcts is important for patient outcomes. While intravenous thrombolytic therapy is a well-established form of treatment in circumstances of cerebral stroke, it has only recently been successfully used in a few incidents of spinal cord ischemia. We present a case of anterior spinal artery (ASA) territory ischemia treated with ASA intra-arterial thrombolytic therapy. A 52-year-old male presented with acute onset of severe lumbar pain, rapidly progressing paraplegia and loss of pain and temperature sensation, with preservation of proprioception and vibratory sensation at the L1 level and below on the right and at the L3 level and below on the left. MRI showed restricted diffusion involving the cord at and below L1 level, with normal cord T2 signal. Digital subtraction spinal angiography showed ASA cutoff in the descending limb at the level of L1. Intra-arterial tissue plasminogen activator (t-PA) combined with verapamil and eptifibatide was administered within the ASA and the patient had significant neurological improvement immediately postoperatively and at 8-month clinical follow-up. Direct ASA intra-arterial thrombolysis is feasible, and this drug combination might be an effective therapy for spinal stroke. Copyright © 2020 Elsevier Ltd. All rights reserved.

Citation

Joseph Haynes, Maksim Shapiro, Eytan Raz, Barry Czeisler, Erez Nossek. Intra-arterial thrombolytic therapy for acute anterior spinal artery stroke. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 2021 Feb;84:102-105

Mesh Tags

Substances

PMID: 33358345

search → result