title: Recurrent artery-to-artery embolism during intravenous t-PA therapy for acute ischemic stroke.
abstract: BACKGROUND
  Treatment of acute ischemic stroke with systemic thrombolysis in the presence of a proximal thrombo-embolic source carries a theoretical risk of thrombus fragmentation and recurrent embolization. Intracardiac thrombus has received the most attention as a potential source of recurrent emboli, and in the past, it was considered a relative contra-indication to tissue plaminogen activator (t-PA) treatment. More recent data show that recurrent embolization from a cardiac source during t-PA infusion is rare.
  
  
  METHODS
  This article describes recurrent symptomatic basilar artery embolization during t-PA infusion from acute thrombus in the proximal cervical vertebral artery.
  
  
  CONCLUSIONS
  This case provides evidence that intravenous t-PA must be used cautiously in the presence of large proximal thrombo-embolic sources and that intraluminal thrombus in a large cervical artery should be considered one such source.
authors.affiliation: Ken and Ruth Davee Department of Neurology and Clinical Neurological Sciences, Feinberg School of Medicine of Northwestern University, Chicago, IL 60611, USA.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Anderson
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Bergman
authors.forename: Richard A
authors.initials: RA
authors.lastname: Bernstein
mesh_terms: D006801:Humans; D007262:Infusions, Intravenous / Q000009:adverse effects*; D020766:Intracranial Embolism / Q000175:diagnosis / Q000209:etiology*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects*
chemical_list: D010959:Tissue Plasminogen Activator