Department of Neurosurgery, Illinois Neurological Institute, University of Illinois College of Medicine, Peoria, Illinois, USA.
Neurosurgery. 2012 Jun;70(6):E1603-7; discussion E1607. doi: 10.1227/NEU.0b013e31822e1097.
The use of intravenous recombinant tissue plasminogen activator (IV rtPA) has become an integral part of modern acute ischemic stroke management; however, its use has been associated with the development of intracranial hemorrhage in 6.4% of patients. It is possible that underlying and unsuspected vascular lesions, such as cerebral aneurysms, may lead to intracranial hemorrhage after IV rtPA thrombolysis.
We present a previously unreported case of a 51-year-old woman who presented with subarachnoid hemorrhage from an acutely ruptured anterior communicating artery aneurysm after IV rtPA treatment for acute left middle cerebral artery thromboembolism. The patient underwent mechanical thromboembolectomy of the left middle cerebral artery occlusion with resultant TIMI (Thrombolysis In Myocardial Infarction) grade I recanalization, followed by coil embolization of the anterior communicating artery aneurysm. The patient never improved neurologically, and she ultimately died.
Screening to identify patients at risk for development of hemorrhagic complications from underlying structural vascular lesions before the use of IV rtPA with computed tomography angiography should be considered.
静脉注射重组组织型纤溶酶原激活物（IV rtPA）的使用已成为现代急性缺血性脑卒中管理的重要组成部分；然而，其使用与 6.4%的患者发生颅内出血有关。可能存在潜在的、未被怀疑的血管病变，如脑动脉瘤，在 IV rtPA 溶栓后可能导致颅内出血。
我们报告了一例先前未报道的病例，一名 51 岁女性因急性左大脑中动脉血栓栓塞接受 IV rtPA 治疗后发生蛛网膜下腔出血，源于急性破裂的前交通动脉动脉瘤。患者接受了左大脑中动脉闭塞的机械血栓切除术，结果 TIMI（血栓溶解治疗心肌梗死）分级为 I 级再通，随后进行了前交通动脉动脉瘤的线圈栓塞。患者的神经功能从未改善，最终死亡。
在使用 IV rtPA 前，应考虑通过计算机断层血管造影术筛查以确定存在潜在结构血管病变导致出血并发症风险的患者。
