Published Online
on May 12, 2005

A more recent version of this article appeared on June 1, 2005

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Submitted on March 15, 2005
Accepted on March 16, 2005

Thrombolytic Therapy for Acute Stroke in Late Pregnancy With Intra-Arterial Recombinant Tissue Plasminogen Activator

David M. Johnson MD; David C. Kramer MD^*; Ezra Cohen MD; Meredith Rochon MD; Mara Rosner MD; and Jesse Weinberger MD

From the Departments of Neurosurgery, Radiology, Anesthesiology, Neurology, Obstetrics, Gynecology, and Reproductive Science, Mount Sinai Medical Center, New York, NY.

^* To whom correspondence should be addressed. E-mail: dkrame01{at}msnyuhealth.org.

Background and Purpose--The most common presentation of ischemic stroke related to pregnancy is arterial occlusion, occurring during the third trimester or postpartum. The authors present the first successful administration of intra-arterial cerebral tissue plasminogen activator to treat an embolic cerebral vascular accident in a 37-week parturient resulting in complete recovery of neurological function.

Methods--The patient presented with left hemiplegia, left-sided neglect, and aphasia. Right internal carotid artery cerebral angiogram showed occlusion of the mid-M1 segment of the middle cerebral artery (MCA). After 15 mg of tissue plasminogen activator was administered via intra-arterial route, there was greatly improved retrograde flow through the posterior communication artery and the MCA territory.

Results--A reduction in size of the MCA occlusion was noted with improvement of antegrade flow through the MCA. Three days after the procedure, the patient was induced successfully and delivered a healthy infant vaginally.

Conclusion--This report describes the use of intra-arterial tissue plasminogen activator in the setting of stroke in late pregnancy.

Key words: cerebral angiography • cerebral infarction • thrombolytic therapy • tissue plasminogen activator

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