Off-label intravenous thrombolysis for early recurrent brain embolism associated with aortic arch thrombus

Ioanna Koutroulou; Georgios Tsivgoulis; Vasileios Rafailidis; Elissavet Psoma; Konstantinos Kouskouras; Panagiotis Fotiadis; Nikolaos Grigoriadis; Theodoros Karapanayiotides

doi:10.1186/s42466-021-00103-6

Off-label intravenous thrombolysis for early recurrent brain embolism associated with aortic arch thrombus

Neurol Res Pract. 2021 Jan 16;3(1):4. doi: 10.1186/s42466-021-00103-6.

Authors

Ioanna Koutroulou¹, Georgios Tsivgoulis^{2

3}, Vasileios Rafailidis⁴, Elissavet Psoma⁴, Konstantinos Kouskouras⁴, Panagiotis Fotiadis¹, Nikolaos Grigoriadis¹, Theodoros Karapanayiotides⁵

Affiliations

¹ Second Department of Neurology, Aristotle University of Thessaloniki, School of Medicine, Faculty of Health Sciences, AHEPA University Hospital, Thessaloniki, Greece.
² Second Department of Neurology, National & Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece.
³ Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA.
⁴ Department of Radiology, Aristotle University of Thessaloniki, School of Medicine, Faculty of Health Sciences, AHEPA University Hospital, Stilponos Kyriakidi 1, 54636, Thessaloniki, Greece.
⁵ Second Department of Neurology, Aristotle University of Thessaloniki, School of Medicine, Faculty of Health Sciences, AHEPA University Hospital, Thessaloniki, Greece. tkarapanayiotides@auth.gr.

Abstract

Safety data of intravenous thrombolysis (IVT) in presence of aortic arch thrombus is scant. Furthermore, IVT is debatable in patients with prior recent stroke. We present a 51-year-old woman with recurrent major infarction 5 days after a minor left MCA territory stroke. She had a floating aortic arch thrombus and she was treated safely and effectively with off-label IVT. Patients with small infarct volumes and mild/no residual neurological deficits after an initial stroke might be considered for IVT in case of early recurrence. IVT may be reasonable in a context of acute severely disabling stroke associated with aortic arch thrombus.

Keywords: Aortic arch thrombus; Brain embolism; Off-label thrombolysis; Stroke.

Publication types

Letter