title: Turning a stroke into a TIA: curative thrombolysis with combined intravenous and intra-arterial tPA.
abstract: Intravenous tissue plasminogen activator (tPA) is standard treatment for eligible patients with acute ischemic stroke, but may be less effective for very severe strokes caused by proximal intracranial artery occlusions. We report the case of a woman with a devastating stroke who recovered completely following emergency revascularization of an occluded proximal middle cerebral artery using a novel treatment approach that combines both intravenous (i.v.) and intra-arterial (IA) tPA. This case illustrates the potential value of the combined i.v.-IA thrombolytic approach, which is an emerging investigational treatment strategy for selected patients with severe acute ischemic stroke.
authors.affiliation: North & East GTA Regional Stroke Centre and Division of Neurology, Department of Medicine and Neuroscience Program, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, ON.
authors.forename: David J
authors.initials: DJ
authors.lastname: Gladstone
authors.forename: Richard I
authors.initials: RI
authors.lastname: Aviv
authors.forename: Babak
authors.initials: B
authors.lastname: Jahromi
authors.forename: Sandra E
authors.initials: SE
authors.lastname: Black
authors.forename: Devra
authors.initials: D
authors.lastname: Baryshnik
authors.forename: Rochelle
authors.initials: R
authors.lastname: Caratao
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Fox
mesh_terms: D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000188:drug therapy*; D007261:Infusions, Intra-Arterial; D007262:Infusions, Intravenous; D008875:Middle Aged; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator