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First case of ischemic stroke which happened during continuous intravenous infusion of rt-PA
Anna Zurawska1, Jaroslaw Czeczotka2, Jacek J Rozniecki3
1Barlicki Memorial Hospital, 22 Kopcinskiego Street, 90-153 Lodz, Poland.
Insights
Catheter-directed thrombolysis (CDT) for acute lower limb ischemia can rarely cause ischemic stroke. Even effective rt-PA treatment during CDT may not prevent stroke in patients with atrial fibrillation.
Area of Science:
- Vascular Surgery
- Neurology
- Interventional Cardiology
Background:
- Catheter-directed thrombolysis (CDT) is a treatment for acute lower limb ischemia.
- Bleeding is the most common complication of CDT.
- Thrombolytic agents are infused directly into the thrombus.
Observation:
- A patient with left lower limb ischemia underwent CDT using recombinant tissue plasminogen activator (rt-PA).
- The patient developed symptoms of ischemic stroke during the rt-PA infusion.
- The patient had a history of atrial fibrillation, suggesting a possible cardiac source for the stroke.
Findings:
- This is the first reported case of ischemic stroke occurring during intra-arterial thrombolysis with rt-PA.
- The stroke was confirmed to be of ischemic etiology.
- The patient's atrial fibrillation history points to a likely embolic stroke mechanism.
Implications:
- Intra-arterial rt-PA, while effective for treating ischemia, may not fully prevent stroke in all patients.
- Effective stroke treatment with rt-PA does not guarantee prevention of a new ischemic event.
- This case highlights the complex interplay between thrombolysis, underlying cardiac conditions, and stroke risk.
Abstract:
Catheter-directed thrombolysis (CDT) is one of the methods in the treatment of patients with acute lower limb ischemia. It is based on intrathrombus infusion of one of the thrombolytic agents. The most common complication of CDT is bleeding. We present a patient with left lower limb ischemia, treated by CDT, in which symptoms of stroke, proved to have ischemic etiology, started during continuous intra-arterial infusion of rt-PA. As the patient presented with the history of atrial fibrillation, the most probable mechanism of stroke was related to detachment of possible intra-atrial thrombus. Ischemic stroke which happened during intra-arterial thrombolysis with rt-PA has never been mentioned in literature yet and the case stands for the statement that very effective causative treatment of ischemic stroke with rt-PA is not sufficient to "prevent" ischemic stroke if used in very small doses.