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Related Concept Videos

Transient Ischemic Attack l: Introduction01:26

Transient Ischemic Attack l: Introduction

A transient ischemic attack (TIA) is a brief episode of neurological dysfunction caused by a temporary, focal reduction in cerebral blood flow. Although symptoms resemble those of an ischemic stroke, the interruption in perfusion is short-lived and does not cause permanent infarction. TIAs are clinically important because they often serve as early warning events for future stroke.Mechanisms of Transient Cerebral IschemiaTransient cerebral ischemia may arise through several mechanisms. One...
Ischemic Stroke l: Introduction01:15

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Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
Ischemic Stroke ll: Pathophysiology01:15

Ischemic Stroke ll: Pathophysiology

An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...
Hemorrhagic Stroke l: Introduction01:17

Hemorrhagic Stroke l: Introduction

A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...
Acute Coronary Syndrome IV: Interprofessional Care01:28

Acute Coronary Syndrome IV: Interprofessional Care

IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
Venous Thrombosis III: Interprofessional Care01:29

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Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...

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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Published on: January 18, 2018

Repeat Intravenous Tenecteplase for Posterior Circulation Stroke Without Completed Infarction.

Kevin Burnham1, Ali Saherwala2, Michael Singh3

  • 1The University of Texas at Tyler School of Medicine, Tyler, Texas; Department of Emergency Medicine, Methodist Health System, Dallas, Texas.

The Journal of Emergency Medicine
|June 11, 2026
PubMed
Summary
This summary is machine-generated.

Repeat intravenous tenecteplase may be a safe and effective treatment for carefully selected patients experiencing early recurrent acute ischemic stroke, particularly in posterior circulation cases. This approach offers rapid neurologic recovery without complications.

Keywords:
cervical artery dissectionischemic stroketenecteplasethrombolytics

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Published on: May 28, 2019

Area of Science:

  • Neurology
  • Emergency Medicine
  • Vascular Neurology

Background:

  • Intravenous thrombolysis is typically contraindicated for early recurrent acute ischemic stroke due to hemorrhagic risks.
  • Limited data exists on repeated tenecteplase use, unlike alteplase, for acute ischemic stroke management.
  • Posterior circulation strokes and vertebral artery dissection pose unique diagnostic and therapeutic challenges.

Purpose of the Study:

  • To report a case of successful repeat intravenous tenecteplase administration in a patient with early recurrent posterior circulation stroke.
  • To highlight the potential safety and efficacy of repeat tenecteplase in selected acute ischemic stroke cases.

Main Methods:

  • A 39-year-old woman with right vertebral artery dissection received initial intravenous tenecteplase for acute posterior circulation stroke.
  • The patient re-presented with symptoms of brainstem ischemia five days later, with imaging showing diminished basilar artery flow.
  • Repeat intravenous tenecteplase was administered approximately 140 hours after the initial dose due to disabling symptoms and absence of completed infarction.

Main Results:

  • The repeat tenecteplase administration led to rapid neurologic recovery and restoration of posterior circulation flow.
  • The patient experienced no thrombolysis-related complications and was discharged neurologically intact.
  • This case suggests repeat tenecteplase may be a viable option in carefully selected patients.

Conclusions:

  • Repeat intravenous tenecteplase can be a safe and effective treatment option for carefully selected patients with early recurrent acute ischemic stroke.
  • Timely neurologic assessment, vascular imaging, and multidisciplinary decision-making are crucial in managing such complex cases.
  • This case expands the limited evidence on repeated tenecteplase use in acute ischemic stroke management.