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Turning a stroke into a TIA: curative thrombolysis with combined intravenous and intra-arterial tPA

Published online by Cambridge University Press:  21 May 2015

David J. Gladstone ,
Richard I. Aviv ,
Babak Jahromi ,
Sandra E. Black ,
Devra Baryshnik ,
Rochelle Caratao  and
Allan J. Fox
David J. Gladstone*
Affiliation:
North & East GTA Regional Stroke Centre and Division of Neurology, Department of Medicine and Neuroscience Program, Sunnybrook and Women's College Health Sciences Centre, Department of Medicine, University of Toronto, Toronto, Ont. Heart and Stroke Foundation Centre for Stroke Recovery
Richard I. Aviv
Affiliation:
Division of Neuroradiology, Department of Medical Imaging, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ont.
Babak Jahromi
Affiliation:
Division of Neuroradiology, Department of Medical Imaging, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ont.
Sandra E. Black
Affiliation:
North & East GTA Regional Stroke Centre and Division of Neurology, Department of Medicine and Neuroscience Program, Sunnybrook and Women's College Health Sciences Centre, Department of Medicine, University of Toronto, Toronto, Ont. Heart and Stroke Foundation Centre for Stroke Recovery
Devra Baryshnik
Affiliation:
North & East GTA Regional Stroke Centre and Division of Neurology, Department of Medicine and Neuroscience Program, Sunnybrook and Women's College Health Sciences Centre, Department of Medicine, University of Toronto, Toronto, Ont.
Rochelle Caratao
Affiliation:
North & East GTA Regional Stroke Centre and Division of Neurology, Department of Medicine and Neuroscience Program, Sunnybrook and Women's College Health Sciences Centre, Department of Medicine, University of Toronto, Toronto, Ont.
Allan J. Fox
Affiliation:
Division of Neuroradiology, Department of Medical Imaging, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ont.
*
Division of Neurology and Regional Stroke Centre, A442 Sunnybrook and Women's College Health Sciences Centre, 2075 Bayview Ave., Toronto ON M4N 3M5

Abstract

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Intravenous tissue plasminogen activator (tPA) is standard treatment for eligible patients with acute ischemic stroke, but may be less effective for very severe strokes caused by proximal intracranial artery occlusions. We report the case of a woman with a devastating stroke who recovered completely following emergency revascularization of an occluded proximal middle cerebral artery using a novel treatment approach that combines both intravenous (IV) and intra-arterial (IA) tPA. This case illustrates the potential value of the combined IV–IA thrombolytic approach, which is an emerging investigational treatment strategy for selected patients with severe acute ischemic stroke.

Keywords

acute ischemic strokeintravenous tPAintra-arterial tPAIV-IA thrombolytic approach
Type
Case Report • Observations de cas
Information
Canadian Journal of Emergency Medicine , Volume 8 , Issue 1 , January 2006 , pp. 54 - 57
Copyright
Copyright © Canadian Association of Emergency Physicians 2006

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