title: Thrombolytic therapy for acute stroke in late pregnancy with intra-arterial recombinant tissue plasminogen activator.
abstract: 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.
authors.affiliation: Department of Neurosurgery, Mount Sinai Medical Center, New York, NY 10029-6574, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Johnson
authors.forename: David C
authors.initials: DC
authors.lastname: Kramer
authors.forename: Ezra
authors.initials: E
authors.lastname: Cohen
authors.forename: Meredith
authors.initials: M
authors.lastname: Rochon
authors.forename: Mara
authors.initials: M
authors.lastname: Rosner
authors.forename: Jesse
authors.initials: J
authors.lastname: Weinberger
mesh_terms: 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*
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator