Abstract
To present the case of a 54-year-old male who suffered from sudden-onset motor aphasia and right-sided weakness on the 14th inpatient day after open-heart surgery for mitral valve replacement. Acute left middle cerebral artery (MCA) occlusion of the M1 segment was found on contrast computed tomographic angiogram of the head. A history of recent major surgery and old intracerebral hemorrhage excluded the patient from intravenous thrombolytic (IVT) therapy. Highly selective local intra-arterial thrombolytic (IAT) therapy was selected for its lower risk of systemic bleeding complication, since symptom onset had occurred 4 hours earlier in this patient. The occluded MCA was completely recanalized after administration of 1, 250, 000 units of intra-arterial urokinase. The patient•s neurological function resumed quickly without early or delayed hemorrhagic complication. The highly selective local IAT may be an alternative therapy in patients with perioperative acute ischemic stroke who are not eligible for IVT therapy.
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