Ischemic strokes after cardiac catheterization: opportune thrombolysis candidates?

Stroke is an important complication after cardiac catheterization procedures, resulting in death and disability for thousands of patients each year. Common risk factors include advanced age, vascular comorbidities, and more complicated and invasive procedures. Several lines of evidence suggest that these strokes are embolic, from either dislodgement of a clot or atheromatous debris off the aortic arch or from thrombus formation on the tip of a guide catheter. These strokes are likely amenable to thrombolysis, although the current literature regarding the use of thrombolysis in this setting is limited to case reports and series. Whether thrombolysis is safe and efficacious remains to be determined, but the existing evidence seems favorable for individual circumstances.