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Updated: Apr 3, 2026

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
A Myocardial Infarction During Intravenous Recombinant Tissue Plasminogen Activator Infusion for Evolving Ischemic
Sabine Fitzek1, Clemens Fitzek
1Departments of *Neurology †Radiology and Neuroradiology, Asklepios Fachklinikum Brandenburg, Brandenburg, Germany.
Introduction:
There are reports of an ischemic stroke during intravenous recombinant tissue-type plasminogen activator (rtPA) for evolving myocardial infarction (MI), and the risk of stroke shortly after an acute MI seems to be higher than in the control population, attributed to intracardiac thrombus formation.
Case Report:
We report a case of fatal MI developing immediately after the start of rtPA infusion for middle cerebral artery stroke in an 88-year-old woman. We assume that the systemic thrombolysis with rtPA led to the fragmentation of an underlying cardiac thrombus, which embolized and occluded the coronary artery and caused MI. This hypothesis is discussed with respect to a short review of the related literature.
Conclusions:
An embolic MI seems to be a rare but serious complication in thrombolysis therapy with rtPA.
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