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Intra-arterial Tissue Plasminogen Activator for Thrombosis Complicating Cerebral Angiography in a 17-Year-Old Girl

Department of Neurology Division of Pediatric Neurology Riley Hospital for Children Indianapolis, Indiana, mgolomb{at}iupui.edu

Mubeen Rafay, MD

Division of Neurology The Hospital for Sick Children Toronto, Ontario

Derek Armstrong, MD

Diagnostic Imaging Division of Neuroradiology The Hospital for Sick Children Toronto, Ontario

Patricia Massicotte, MD, MSc

Division of Hematology The Hospital for Sick Children Toronto, Ontario

Rosalind Curtis, MD

Division of Neurology, The Hospital for Sick Children Toronto, Ontario

Selina Hune, MSc, ACNP

Division of Neurology, The Hospital for Sick Children Toronto, Ontario

Gabrielle A. deVeber, MD

Division of Neurology, The Hospital for Sick Children Toronto, Ontario

Few reports describe the use of intra-arterial recombinant tissue plasminogen activator to treat intracranial thrombosis in children. A 17-year-old girl with a history of prior venous thrombosis developed a left middle cerebral artery thrombus during diagnostic cerebral angiogram. Therapy with intra-arterial tissue plasminogen activator was initiated. An immediate follow-up angiogram demonstrated recanalization, and diffusion-weighted magnetic resonance imaging 9 hours later showed no evidence of infarction. Following the angiogram, femoral artery thrombosis developed. Treatment with supratherapeutic levels of heparin, localized delivery of intraarterial tissue plasminogen activator, embolectomy, danaparoid, and dipyridamole failed to re-establish perfusion to the lower leg, and below the knee amputation was required. Neurologic examination remained normal 1 year later. Cerebral damage was avoided with the use of emergency intra-arterial tissue plasminogen activator for cerebral artery thrombosis in this child. (J Child Neurol 2003;18:420—423).

Journal of Child Neurology, Vol. 18, No. 6, 420-423 (2003)
DOI: 10.1177/08830738030180060301


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