Introduction: Treatment of acute ischemic stroke with systemic thrombolysis in the presence of a proximal thrombo-embolic source carries
a theoretical risk of thrombus fragmentation and recurrent embolization. Intracardiac thrombus has received the most attention
as a potential source of recurrent emboli, and in the past, it was considered a relative contra-indication to tissue plaminogen
activator (t-PA) treatment. More recent data show that recurrent embolization from a cardiac source during t-PA infusion is
rare.
Case Report: This article describes recurrent symptomatic basilar artery embolization during t-PA infusion from acute thrombus in the
proximal cervical vertebral artery.
Discussion: This case provides evidence that intravenous t-PA must be used cautiously in the presence of large proximal thrombo-embolic
sources and that intraluminal thrombus in a large cervical artery should be considered one such source.
Key Words Recurrent embolism - acute ischemic stroke - tissue plasminogen activator - artery-to-artery embolism