A case of acute recanalization therapy for left middle cerebral artery occlusion during the first trimester of pregnancy

Abstract

Objective: The safety of intravenous thrombolysis with rt-PA and mechanical thrombectomy during pregnancy is not well confirmed. We report a case of acute ischemic stroke during the first trimester of pregnancy that was treated with reperfusion therapy. Presentation: Aphasia and right hemiplegia developed suddenly in a 27-year-old pregnant woman. The left middle cerebral artery was occluded, and we performed reperfusion therapy by intravenous administration of rt-PA and mechanical thrombectomy. The patient's neurologic status improved immediately. Postoperative transesophageal echocardiography revealed patent foramen ovale; therefore, paradoxical embolism was diagnosed. Conclusion: Reperfusion therapy can be performed relatively safely in pregnant woman but its effects on the fetus must be considered.