RECURRENT EMBOLIZATION DURING INTRAVENOUS ADMINISTRATION OF TISSUE-PLASMINOGEN ACTIVATOR IN ACUTE CARDIOEMBOLIC STROKE - A CASE-REPORT

Treatment with recombinant tissue plasminogen activator (rt-PA) has be en applied in acute cardioembolic stroke to reopen the occluded vessel and improve the patient's neurologic deficit. However, the effect of this therapy on intracardiac thrombus has not been documented previous ly. A forty-five-year-old man with dilated cardiomyopathy developed ac ute cardioembolic stroke with disturbance of consciousness, right hemi anopia, right hemiplegia, and global aphasia. Cerebral angiography dem onstrated occlusion of the left middle cerebral artery trunk. Intraven ous administration of 30 megaunits (MU) of recombinant tissue plasmino gen activator was commenced two hours after the ictus and completed wi thin sixty minutes. Cerebral angiography was repeated just after this treatment and demonstrated a new occlusion of the left intracranial in ternal carotid artery along with occlusion of a branch of the left ext ernal artery. The authors subsequently performed two-dimensional echoc ardiography and found a mobile thrombus in the left ventricle. In pati ents with intracardiac mobile thrombi, recombinant tissue plasminogen activator seems to accelerate breakup or detachment of the thrombi and subsequent recurrent embolization. Therefore, it seems better to pay attention to the presence of mobile intracardiac thrombus before comme ncing intravenous infusion of rt-PA.