Intra-Arterial Thrombolysis is Associated with Delayed Reperfusion of Remaining Vessel Occlusions following Incomplete Thrombectomy

A patient with a persistent perfusion deficit after receiving IA urokinase. A, The first DSA shows left-sided occlusions of the M2 MCA segment (left panel). The last DSA series after MT shows that the patient has achieved reperfusion of 50% of the initial target territory (eTICI 2b50) (right panel). DSA runs are shown with high contrast in order to emphasize the capillary phase deficits. Areas in red show nonreperfused territory. B, Follow-up MR imaging performed 24 hours after the end of the intervention. DWI shows a newly developed distal infarct (left panel). Postprocessed perfusion imaging shows a persistent perfusion deficit that directly corresponds to the nonreperfused territory from the final DSA series (right panel).