Related Experiment Video
Updated: Jun 8, 2026

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Unruptured Cerebral Aneurysm Detected after Intravenous Tissue Plasminogen Activator for Stroke
Yukihiro Yoneda1, Shinji Yamamoto, Yoshie Hara
1Division of Neurology, Kobe Red Cross Hospital and Hyogo Emergency Medical Center, Kobe City, Japan.
Abstract:
Therapeutic guidelines of intravenous thrombolysis with tissue plasminogen activator (tPA) for hyperacute ischemic stroke are very strict. Because of potential higher risk of bleeding complications, the presence of unruptured cerebral aneurysm is a contraindication for systemic thrombolysis with tPA. According to the standard CT criteria, a 66-year-old woman who suddenly developed aphasia and hemiparesis received intravenous tPA within 3 h after ischemic stroke. Magnetic resonance angiography during tPA infusion was performed and the presence of a small unruptured cerebral aneurysm was suspected at the anterior communicating artery. Delayed cerebral angiography confirmed an aneurysm with a size of 7 mm. The patient did not experience any adverse complications associated with the aneurysm. Clinical experiences of this kind of accidental off-label thrombolysis may contribute to modify the current rigid tPA guidelines for stroke.
Related Concept Videos
Transient Ischemic Attack l: Introduction
Aneurysm III: Interprofessional Care
Aneurysm II: Clinical Manifestations and Diagnostic Studies
Ischemic Stroke ll: Pathophysiology
