Thromboaspiration in a Patient With Persisting Intracranial Occlusion After Intravenous Thrombolysis: A Case Report

Fabrizio Sallustio, Silvia Di Legge, Domenico Sama, Giacomo Koch, Matteo Stefanini, Costantino Del Giudice, Enrico Pampana, Roberto Gandini, Paolo Stanzione, Giovanni Simonetti


The last few years have been characterized by a rapid diffusion of endovascular treatments aimed at achieving arterial recanalization in patients with acute ischemic stroke. Clinical trials have shown higher rates of arterial recanalization being achieved by the Penumbra System (PS) as compared to standard treatment, i.e. systemic thrombolysis by recombinant tissue plasminogen activator (rtPA). This case-report enhances the relevance of strict patient monitoring during and after rtPA administration in order to consider urgent mechanical thrombectomy as additional treatment in highly selected cases. A 69-year-old woman presented with sudden onset of left hemiparesis and slurred speech. Systemic rtPA was administered with marked clinical improvement. Ultrasound study performed during rtPA infusion suggested intracranial occlusion. Diffusion-weighted MRI was negative for acute ischemia, perfusion-weighted imaging detected a wide region of hypoperfused tissue in the right middle cerebral artery (MCA) territory, and MR angiography detected right proximal MCA occlusion. After the initial clinical improvement, the patient deteriorated. Clot aspiration by the PS and complete recanalization were achieved in 56 minutes. The patient was discharged with mild left hemiparesis, and she had excellent recovery at 6 months. Acute endovascular treatment by the PS proved successful in this patient experiencing clinical fluctuations due to persisting intracranial artery occlusion after systemic thrombolysis. Strict patient monitoring by MRI and ultrasound studies may allow prompt mobilization of the interventional radiology team thus offering an increased chance of favourable outcome and preventing more invalidating strokes in patients known to benefit poorly by systemic thrombolysis.

J Neurol Res. 2012;2(1):33-35


Ischemic stroke; Intracranial artery occlusion; Thrombolysis; Endovascular treatment; Penumbra system

Full Text: HTML PDF

Browse  Journals  


Journal of Clinical Medicine Research

Journal of Endocrinology and Metabolism

Journal of Clinical Gynecology and Obstetrics


World Journal of Oncology

Gastroenterology Research

Journal of Hematology


Journal of Medical Cases

Journal of Current Surgery

Clinical Infection and Immunity


Cardiology Research

World Journal of Nephrology and Urology

Cellular and Molecular Medicine Research


Journal of Neurology Research

International Journal of Clinical Pediatrics



Journal of Neurology Research, biannually, ISSN 1923-2845 (print), 1923-2853 (online), published by Elmer Press Inc.                     
The content of this site is intended for health care professionals.
This is an open-access journal distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons Attribution license (Attribution-NonCommercial 4.0 International CC-BY-NC 4.0)

This journal follows the International Committee of Medical Journal Editors (ICMJE) recommendations for manuscripts submitted to biomedical journals,
the Committee on Publication Ethics (COPE) guidelines, and the Principles of Transparency and Best Practice in Scholarly Publishing.

website:   editorial contact:
Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada

© Elmer Press Inc. All Rights Reserved.

Disclaimer: The views and opinions expressed in the published articles are those of the authors and do not necessarily reflect the views or opinions of the editors and Elmer Press Inc. This website is provided for medical research and informational purposes only and does not constitute any medical advice or professional services. The information provided in this journal should not be used for diagnosis and treatment, those seeking medical advice should always consult with a licensed physician.