Vascular occlusion in a previously unaffected territory after treatment with intravenous plasminogen activator: illustrative case.
J Neurosurg Case Lessons
; 1(15): CASE20175, 2021 Apr 12.
Article
em En
| MEDLINE
| ID: mdl-36046799
ABSTRACT
BACKGROUND:
Intravenous tissue plasminogen activator (IV t-PA) is effective for the treatment of distal artery occlusion. However, after the use of IV t-PA, vascular occlusion in unaffected territories may occur. Early recurrent ischemic stroke (ERIS) is defined as the occurrence of new neurological symptoms that suggest the involvement of initially unaffected vascular territories after intravenous thrombolysis (IVT). The authors reviewed the cases of ERIS that occurred within 24 hours after treatment with IVT. OBSERVATIONS A 75-year-old woman with occlusion in the M2 segment of the left middle cerebral artery (MCA) was treated with IV t-PA. However, 360 minutes later, the patient presented with occlusion in the M1 distal segment of the contralateral side, the right MCA, which was recanalized by endovascular treatment. Her modified Rankin Scale score was 4; however, aphasia was not observed. She was transferred to a rehabilitation hospital after 3 months. LESSONS ERIS is an extremely rare but catastrophic event. The underlying mechanism of ERIS most likely involves the disintegration and subsequent scattering of a preexisting intracardiac thrombus. Hence, caution must be used when managing not only hemorrhagic complications but also ischemic complications after IV t-PA. Endovascular management may be the only effective treatment for this type of large vessel occlusion.
CT = computed tomography; ERIS = early recurrent ischemic stroke; ICH = intracranial hemorrhage; IV t-PA = intravenous tissue plasminogen activator; IVT = intravenous thrombolysis; MCA = middle cerebral artery; MT = mechanical thrombectomy; NIHSS = National Institutes of Health Stroke Scale; PCI = percutaneous coronary intervention; STEMI = ST-elevation myocardial infarction; TICI = thrombolysis in cerebral infarction; endovascular treatment; ischemic complication; mRS = modified Rankin Scale; tissue plasminogen activator
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Coleções:
01-internacional
Base de dados:
MEDLINE
Idioma:
En
Revista:
J Neurosurg Case Lessons
Ano de publicação:
2021
Tipo de documento:
Article