Anterior Communicating Artery Aneurysm Rupture After Intravenous Thrombolysis for Acute Middle Cerebral Artery Thromboembolism

Author:

Rammos Stylianos K.1,Neils David M.1,Fraser Kenneth2,Klopfenstein Jeffrey D.1

Affiliation:

1. Department of Neurosurgery, Illinois Neurological Institute, University of Illinois College of Medicine

2. Department of Radiology, OSF Saint Francis Medical Center, Peoria, Illinois

Abstract

Abstract BACKGROUND AND IMPORTANCE: The use of intravenous recombinant tissue plasminogen activator (IV rtPA) has become an integral part of modern acute ischemic stroke management; however, its use has been associated with the development of intracranial hemorrhage in 6.4% of patients. It is possible that underlying and unsuspected vascular lesions, such as cerebral aneurysms, may lead to intracranial hemorrhage after IV rtPA thrombolysis. CLINICAL PRESENTATION: We present a previously unreported case of a 51-year-old woman who presented with subarachnoid hemorrhage from an acutely ruptured a nterior communicating artery aneurysm after IV rtPA treatment for acute left middle cerebral artery thromboembolism. The patient underwent mechanical thromboembolectomy of the left middle cerebral artery occlusion with resultant TIMI (Thrombolysis In Myocardial Infarction) grade I recanalization, followed by coil embolization of the anterior communicating artery aneurysm. The patient never improved neurologically, and she ultimately died. CONCLUSION: Screening to identify patients at risk for development of hemorrhagic complications from underlying structural vascular lesions before the use of IV rtPA with computed tomography angiography should be considered.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Clinical Neurology,Surgery

Reference2 articles.

1. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group;Tissue plasminogen activator for acute ischemic stroke;N Engl J Med,1995

2. Cerebral aneurysm rupture after r-TPA thrombolysis for acute myocardial infarction;Lagares;Surg Neurol,1999

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