57-year-old woman with a left chronic discoloration of the iris and the other ocular manifestation shown in the pic (taken from his ID) .
According relative history the patient has DM, HTN, IHD, while the ocular findings dated to birth.
Patient came to our hospital due to acute onset of aphasia started 4 hours before presentation
Perfusion image showed mismatch
Due to late presentation beyond 3.5 hours patient shifted to Cath lab where the following was apparent ????
Lt CCA injection
RT ICA injection
so we not sure about presence of Acom so we decided to inject TPA IA from Post circulation through leptomeningeal collaterals from Lt PCA
Microcatheter in Lt PCA during IA -rtpa injection
Basilar injection after recanalization
final Rt ICA injection after recanalization
( look at disappearance of previously apparent inter cavernous anastomosis )
CT bone window and 3d bone axial proving the absence of carotid canal
Question for discussion is there any EBM for IA-Thrombolysis ?