Thrombolytic therapy for acute stroke in late pregnancy with intra-arterial recombinant tissue plasminogen activator [Case Report]
Johnson, David M; Kramer, David C; Cohen, Ezra; Rochon, Meredith; Rosner, Mara; Weinberger, Jesse
BACKGROUND AND PURPOSE: The most common presentation of ischemic stroke related to pregnancy is arterial occlusion, occurring during the third trimester or postpartum. The authors present the first successful administration of intra-arterial cerebral tissue plasminogen activator to treat an embolic cerebral vascular accident in a 37-week parturient resulting in complete recovery of neurological function. METHODS: The patient presented with left hemiplegia, left-sided neglect, and aphasia. Right internal carotid artery cerebral angiogram showed occlusion of the mid-M1 segment of the middle cerebral artery (MCA). After 15 mg of tissue plasminogen activator was administered via intra-arterial route, there was greatly improved retrograde flow through the posterior communication artery and the MCA territory. RESULTS: A reduction in size of the MCA occlusion was noted with improvement of antegrade flow through the MCA. Three days after the procedure, the patient was induced successfully and delivered a healthy infant vaginally. CONCLUSIONS: This report describes the use of intra-arterial tissue plasminogen activator in the setting of stroke in late pregnancy.
PMID: 15914759
ISSN: 1524-4628
CID: 2635042