Intra-Arterial Thrombolysis in Second Trimester of Pregnancy. A Case Report

Abstract

Here we present a successful intra-arterial thrombolysis performed in the second trimester of pregnancy (21 weeks). The intervention resulted in complete recanalization of the occluded right middle cerebral artery and favourable clinical and gestational outcome. Together with cases described in respective medical literature our report affirms that in pregnancy acute ischemic stroke could be treated effectively applying intra-arterial thrombolysis (using rt-PA). This therapy could provide opportunity to help in such desperate situations.

Alteplase Therapy for Acute Ischemic Stroke in Pregnancy: Two Case Reports and a Systematic Review of the Literature

“…Our two pregnant patients with AIS showed short‐term improvement in functional status after receiving IV alteplase. This adds to most of the published case reports (n=27) with documented neurologic improvement and without fetal complications (Table ) . There are five case reports with negative outcomes in the mother, fetus, or both after the administration of alteplase .…”

“…Review of references identified an additional case report. 11 An additional six cases from four abstracts have been reported in abstract form only. [12][13][14][15] Review of abstracts from national meeting presentations identified national database reviews that significantly increased the overall number of reported cases, although individual patient demographics, presentations, interventions, and outcomes were not reported in these.…”

“…However, it is a large molecule and is unlikely to cross the human placenta . Although most published cases occurred in the first trimester, alteplase appears to be safe in the second and third trimesters as well …”

“…Twenty‐four individual patient cases from 21 articles were included. Review of references identified an additional case report . An additional six cases from four abstracts have been reported in abstract form only .…”