Thrombolysis for Acute Ischemic Stroke Following Transcatheter Aortic Valve Replacement: Case Report and Literature Review

The Neurologist
Ashwin Malhotra, Alan Z Segal

Abstract

Intravenous thrombolytic therapy with recombinant tissue type plasminogen activator (IV-tPA) is the first-line treatment option for acute ischemic stroke (AIS). The tPA exclusion criteria, defined decades ago, require updates as new technologies emerge. Transcatheter aortic valve replacement (TAVR), which has begun to replace open surgery, poses a risk for acute stroke and falls outside of prior tPA guidelines. Here we describe a post-TAVR patient treated safely with IV-tPA for presumed AIS. Previously undescribed, we suggest that tPA should be considered for post-TAVR AIS patients who otherwise satisfy inclusion and exclusion criteria.

References

Mar 1, 2008·Journal of the American College of Cardiology·Pooja KhatriUNKNOWN Treatment of Acute Stroke after Cardiac Catheterization (TASCC) Study Group
Mar 20, 2012·The Journal of Thoracic and Cardiovascular Surgery·D Craig MillerUNKNOWN PARTNER Stroke Substudy Writing Group and Executive Committee
Oct 20, 2015·Journal of the American College of Cardiology·George D DangasUNKNOWN BRAVO-3 Investigators
Dec 27, 2016·JACC. Cardiovascular Imaging·Melissa A DaubertPamela S Douglas
Apr 16, 2017·Stroke; a Journal of Cerebral Circulation·Rodrigo BagurMamas A Mamas
Sep 25, 2017·Stroke; a Journal of Cerebral Circulation·Nicolas VoelkelGordian Jan Hubert

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