Thrombolytic therapy for acute stroke in late pregnancy with intra-arterial recombinant tissue plasminogen activator.
OBJECTIVE
The most common presentation of ischemic stroke related to pregnancy is arterial occlusion, occurring during the third trimester or postpartum. The authors present the first successful administration of intra-arterial cerebral tissue plasminogen activator to treat an embolic cerebral vascular accident in a 37-week parturient resulting in complete recovery of neurological function.


METHODS
The patient presented with left hemiplegia, left-sided neglect, and aphasia. Right internal carotid artery cerebral angiogram showed occlusion of the mid-M1 segment of the middle cerebral artery (MCA). After 15 mg of tissue plasminogen activator was administered via intra-arterial route, there was greatly improved retrograde flow through the posterior communication artery and the MCA territory.


RESULTS
A reduction in size of the MCA occlusion was noted with improvement of antegrade flow through the MCA. Three days after the procedure, the patient was induced successfully and delivered a healthy infant vaginally.


CONCLUSIONS
This report describes the use of intra-arterial tissue plasminogen activator in the setting of stroke in late pregnancy.
Johnson
David M
DM
Department of Neurosurgery, Mount Sinai Medical Center, New York, NY 10029-6574, USA.
Kramer
David C
DC
Cohen
Ezra
E
Rochon
Meredith
M
Rosner
Mara
M
Weinberger
Jesse
J
D000328:Adult; D000792:Angiography / Q000379:methods; D001158:Arteries / Q000473:pathology*; D002339:Carotid Arteries / Q000473:pathology; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D020768:Middle Cerebral Artery / Q000473:pathology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000628:therapy*; D011256:Pregnancy Outcome; D011994:Recombinant Proteins / Q000627:therapeutic use*; D020521:Stroke / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator