Abstract
A 76-year-old woman suffered from intractable paroximal arterial fibrillation after aortic valve replacement for aortic stenosis. The patient developed complete right hemiplegia and motor aphasia on the fifteenth day after surgery. At the onset of stroke, the patient’s NIHSS score was 16. Initial head CT revealed neither hemorrhage nor early ischemic changes. Complete occlusion of the distal M1 portion of the middle cerebral artery was identified via 3D-CT angiography. Intravenous recombinant tissue plasminogen activator (rt-PA) therapy was initiated 140 minutes after the onset of symptoms. The patient showed remarkable improvement (the NIHSS score reduced to 4) without the occurrence of surgical site bleeding. The risk of ischemic stroke is increased during the perioperative period, especially after cardiac surgery. Intraarterial thrombolysis for postoperative stroke has been reported. However reports of intravenous rt-PA administration for postoperative stroke are scarce because postoperative stroke mostly occurs within 2 weeks of surgery and are excluded based on the guidelines. This report contributes to the investigation of the efficacy and safety of intravenous rt-PA administration.
