Peripheral embolization following thrombolytic therapy for acute ischemic stroke\u2014a case report

Tamer Roushdy,Eman Hamid,Hany Aref,Nevine El Nahas,Mai Fathy,Islam Bastawy

doi:10.1186/s41983-020-00231-x

Abstract

BackgroundIntravenous recombinant tissue plasminogen activator is the only golden approved medical therapy for acute ischemic stroke, guidelines for its injection relay on reducing or preventing associated hemorrhage as a side effect, yet hemorrhage is not the only possible complication, further embolization following injection is also a possibility; in this case report, peripheral embolization following intravenous recombinant tissue plasminogen activator with two possible explanations one related to the treatment and another related to the patient liability is represented.Case presentationA 78-year-old male presenting with acute onset of stroke, received intravenous recombinant tissue plasminogen activator, 16 h later he developed acute limb ischemia.ConclusionPeripheral embolization may happen within hours from intravenous recombinant tissue plasminogen activator administration.

Highlights

BackgroundCaring for stroke patients after intravenous recombinant tissue plasminogen activator (IV rt-PA) is important as an injection decision
Intravenous recombinant tissue plasminogen activator is the only golden approved medical therapy for acute ischemic stroke, guidelines for its injection relay on reducing or preventing associated hemorrhage as a side effect, yet hemorrhage is not the only possible complication, further embolization following injection is a possibility; in this case report, peripheral embolization following intravenous recombinant tissue plasminogen activator with two possible explanations one related to the treatment and another related to the patient liability is represented
Caring goes beyond vital data, to involve detecting and avoiding any possible complications from rt-PA [1]

Summary

Background

Caring for stroke patients after intravenous recombinant tissue plasminogen activator (IV rt-PA) is important as an injection decision. Case presentation A 78-year-old male, hypertensive, ischemic heart disease patient with previous transthoracic echocardiography in 2015 showing dilated left atrium and left ventricle (LV), with impaired LV systolic functions (ejection fraction (EF) measured by modified Simpsons’ method was 40%), LV diastolic dysfunction impaired relaxation pattern, normal. Transthoracic echocardiography (Vivid E9 machine, General Electric, Vingmed Ultrasound, Horten, Norway) done after surgery revealed 19 × 14 mm apical LV thrombus, dilated LV dimensions, with impaired LV systolic functions (ejection EF measured by modified Simpsons’ method was 35%), akinetic all apical segment, whole anterior wall and anterior septum, impaired LV diastolic function with impaired relaxation pattern with mild mitral and tricuspid valve regurgitation (Fig. 1b). Twenty-four hours Holter ECG (General Electric Health care, MARS, Milwaukee, USA) showed sinus rhythm with no detectable atrial fibrillation

Discussion

Conclusion