Cases receiving intravenous thrombolysis for acute ischemic stroke occurring during hospitalization for transient ischemic attack

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  • Tanaka Koji
    Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
  • Uehara Toshiyuki
    Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
  • Kobayashi Junpei
    Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
  • Ohara Tomoyuki
    Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
  • Nagatsuka Kazuyuki
    Department of Neurology, National Cerebral and Cardiovascular Center
  • Minematsu Kazuo
    Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
  • Toyoda Kazunori
    Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center

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  • 一過性脳虚血発作で入院中に発症した虚血性脳卒中に対しrt-PA 静注療法を施行した症例の検討

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Background and Purpose: Transient ischemic attack (TIA) is a high risk of subsequent ischemic stroke. We have reported one case receiving intravenous recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke occurring during hospitalization for TIA. We analyzed other consecutive patients receiving rt-PA for acute ischemic stroke occurring during hospitalization for TIA. Methods: We reviewed four cases (2 males and 2 females, aged from 74 to 89 years) from our facility’s rt-PA database between October 2005 and December 2013. Results: The ABCD2 score of preceding TIA ranged from 4 to 6. Three of the four patients had atrial fibrillation and major artery occlusion on admission and/or time of the occurrence of subsequent ischemic stroke. Diffusion weighted imaging (DWI) on admission revealed a hyperintense lesion in the left medial thalamus in one patient. Elapsed time from the index TIA to the time of occurrence of ischemic stroke ranged from 2 hours to 3 days. The National Institutes of Health Stroke Scale score at the onset of ischemic stroke ranged from 7 to 30. The onset-to-treatment time of rt-PA was 33, 33, 160, and 170 minutes, respectively. Modified Rankin Scale score at 90 days was 0 in 2 patients and 5 in one patient. The other one patient could not be followed up. Conclusions: Patients with TIA being at high risk for subsequent ischemic stroke should be immediately hospitalized. To avoid delay in timely treatment including acute revascularization therapy, occurrence of subsequent ischemic stroke should be always kept in mind.

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