Early embolic events complicating intravenous thrombolysis for acute ischemic stroke.
Intravenous recombinant tissue plasminogen activator (IV rt-PA) is the only established thrombolytic therapy for acute ischemic stroke. However, secondary embolism after IV rt-PA for acute ischemic stroke is recognized as an uncommon complication, and the pathophysiology is unclear. We describe a 72-year-old man with acute infarction in the territory of left anterior cerebral artery who developed new infarction in the territory of right middle cerebral artery and acute peripheral arterial occlusion after IV rt-PA therapy. It suggested a central embolic source. Because the patient has paroxysmal atrial fibrillation (Af), the possible embolic sources may come from fragmentation of pre-existing intra-atrial clot. Although Af and the presence of cardiac thrombus are not contraindication for IV rt-PA in acute ischemic stroke, our case and review suggested that the administration of IV rt-PA to patients with known Af and intracardiac thrombus could represent a particular risk situation and should be carefully evaluated.
Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan.
Ping Song
PS
Chou
Chien Hung
CH
Lin
Hai Lun
HL
Chao
A Ching
AC
Chao
D000368:Aged; D002544:Cerebral Infarction / Q000150:complications / Q000188:drug therapy*; D003324:Coronary Artery Disease / Q000150:complications*; D004636:Emergency Service, Hospital; D017809:Fatal Outcome; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000150:complications*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator