A patient with right internal carotid artery territory infarctionduring intravenous recombinant tissue plasminogen activator treatment for left middle cerebral artery territory ischemic stroke

Abstract

We report a patient with right internal carotid artery (ICA) territory infarction during intravenous recombinant tissue plasminogen activator (rt-PA) therapy for left middle cerebral artery (MCA) territory ischemic stroke. A 79 year-old woman with a history of atrial fibrillation received intravenous rt-PA for left MCA territory infarction. However, a right ICA territory infarction developed 37 min after the start of intravenous rt-PA. This patient is considered to have suffered an early recurrent ischemic stroke (ERIS), which is defined as the early occurrence of new neurological symptoms, suggesting the involvement of initially unaffected vascular territories in the absence of intracranial hemorrhage. Cardiogenic embolism or artery to artery embolism is considered to be the cause of ERIS. It is important to identify cardiac embolism as well as presence of floating plaques in the carotid arteries before intravenous rt-PA treatment to avoid the development of ERIS.