The management of stroke during intraarterial thrombolysis

Intraarterial thrombolytic therapy is being increasingly used in the treatment of acute limb ischaemia. When strokes occur during thrombolytic therapy treatment is usually stopped because of the suspicion of cerebral haemorrhage. If the stroke is not haemorrhagic then stopping the treatment jeopardizes the ischaemic limb. If the stroke is proven to be non-haemorrhagic on computed tomography (CT) then the thrombolytic therapy should be recommenced. We present three case histories of patients who suffered a stroke during thrombolytic therapy over a 30-month period, in whom CT confirmed non-haemorrhagic stroke and we suggest that managing the ischaemic limb with anticoagulant and thrombolytic therapy can be safe in the early period following the stroke. We also discuss the probable aetiology of the strokes and whether cardiac echocardiography should be performed in these patients.