Intra-arterial Tirofiban after Intravenous Thrombolysis in a Patient with Capsular warning syndrome: A case report

Abstract

Abstract Background: Capsular warning syndrome (CWS) is a special type of transient ischemic attack syndrome with a high risk to progress into a stroke with a permanent disability. An effective and standard therapy has not yet been established. Case presentation: We report a 57-year-old man who experienced 4 episodes of dysarthria andleft-sided hemiplegia. He was diagnosed with CWS and treated by r-tPA intravenous thrombolysis (IVT) in the third episode. He achieved a transient remission after IVT. However, he developed more severe and persistent symptoms with a National Institute of Health Stroke Scale (NIHSS) score of 8 points at the fourth attack. Intra-arterial tirofiban was administered as remedial therapy and the patient achieved a favorable outcome with a modified Rankin Scale score of 0 at the 3-month follow-up. Conclusion: Intra-arterial tirofiban may act as an effective and safe remedial therapy for patients with CWS who failed to respondto IVT.