Recurrent artery-to-artery embolism during intravenous t-PA therapy for acute ischemic stroke

Author： Anderson Christopher Bergman Deborah Bernstein Richard

ISSN： 1541-6933

Source： Neurocritical Care, Vol.3, Iss.1, 2005-08, pp. : 54-56

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Abstract

Introduction: 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.Case Report: This article describes recurrent symptomatic basilar artery embolization during t-PA infusion from acute thrombus in the proximal cervical vertebral artery.Discussion: 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.