Late intra-arterial thrombolysis

A 70-year-old woman with a progressive dominant hemisphere syndrome but only mild hemiparesis and a normal brain scan (>3 hours from stroke onset) showed angiographic occlusion of the left anterior cerebral artery and the middle cerebral artery at its trifurcation with preservation of the rolandic artery. Intra-arterial thrombolysis was started >6 hours from onset of symptoms. Recanalization occurred and the patient recovered with a transcortical motor aphasia and no motor deficit. A negative brain scan and an incomplete large hemispheric syndrome may indicate an extended time-window for intra-arterial thrombolysis.