title: Intra-arterial tissue plasminogen activator for thrombosis complicating cerebral angiography in a 17-year-old girl.
abstract: Few reports describe the use of intraarterial recombinant tissue plasminogen activator to treat intracranial thrombosis in children. A 17-year-old girl with a history of prior venous thrombosis developed a left middle cerebral artery thrombus during diagnostic cerebral angiogram. Therapy with intra-arterial tissue plasminogen activator was initiated. An immediate follow-up angiogram demonstrated recanalization, and diffusion-weighted magnetic resonance imaging 9 hours later showed no evidence of infarction. Following the angiogram, femoral artery thrombosis developed. Treatment with supratherapeutic levels of heparin, localized delivery of intra-arterial tissue plasminogen activator, embolectomy, danaparoid, and dipyridamole failed to re-establish perfusion to the lower leg, and below the knee amputation was required. Neurologic examination remained normal 1 year later. Cerebral damage was avoided with the use of emergency intra-arterial tissue plasminogen activator for cerebral artery thrombosis in this child.
authors.affiliation: The Hospital for Sick Children, Toronto, Ontario. mgolomb@iupui.edu
authors.forename: Meredith R
authors.initials: MR
authors.lastname: Golomb
authors.forename: Mubeen
authors.initials: M
authors.lastname: Rafay
authors.forename: Derek
authors.initials: D
authors.lastname: Armstrong
authors.forename: Patricia
authors.initials: P
authors.lastname: Massicotte
authors.forename: Rosalind
authors.initials: R
authors.lastname: Curtis
authors.forename: Selina
authors.initials: S
authors.lastname: Hune
authors.forename: Gabrielle A
authors.initials: GA
authors.lastname: deVeber
mesh_terms: D000293:Adolescent; D002533:Cerebral Angiography; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D007261:Infusions, Intra-Arterial; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator