j bursa med Journal of Bursa Faculty of Medicine 2980-0218 University of Health Sciences 10.61678/bursamed.1537262 Clinical Sciences (Other) Klinik Tıp Bilimleri (Diğer) Thrombolytic therapy in acute ischemic stroke during pregnancy: A case report Thrombolytic therapy in acute ischemic stroke during pregnancy: A case report https://orcid.org/0000-0002-9679-8007 Haki Cemile Bursa City Hospital https://orcid.org/0009-0000-7587-5440 Ay Beyza Nur Bursa City Hospital https://orcid.org/0000-0002-3481-7225 Evren Ayfer Burtom Biyofiz Nilüfer Medical Center https://orcid.org/0000-0003-4281-3301 Kamisli Suat Bursa City Hospital 01 31 2025 3 1 8 12 08 22 2024 09 16 2024 Copyright © 2023, Journal of Bursa Faculty of Medicine 2023 Journal of Bursa Faculty of Medicine

Intravenous tissue plasminogen activator (IV tPA) is a proven treatment method for acute ischemic stroke. In this report, we share a case where IV tPA treatment was administered during the 6th week of pregnancy due to acute ischemic stroke, and there were no problems in the mother and baby during long-term follow-up. Here, we present a 32-year-old female patient, in the 6th week of her pregnancy, presented to our emergency department at the 47th minute of the onset of symptoms. National Institute of Health Stroke Scale (NIHSS) score was 10. On diffusion-weighted magnetic resonance imaging (MRI), an infarction was observed in the right middle cerebral artery, and on cranial MR angiography, a thrombus was detected at the level of the right middle cerebral artery M2-3. Thrombolytic therapy was initiated 90 minutes after the onset of the first symptoms. No maternal or fetal problems were detected. The patient had a Modified Rankin Score of 0 at 3 months. We administered IV tPA treatment to the pregnant patient who presented with severe stroke symptoms considering the benefits outweighed the risks.

Intravenous tissue plasminogen activator (IV tPA) is a proven treatment method for acute ischemic stroke. In this report, we share a case where IV tPA treatment was administered during the 6th week of pregnancy due to acute ischemic stroke, and there were no problems in the mother and baby during long-term follow-up. Here, we present a 32-year-old female patient, in the 6th week of her pregnancy, presented to our emergency department at the 47th minute of the onset of symptoms. National Institute of Health Stroke Scale (NIHSS) score was 10. On diffusion-weighted magnetic resonance imaging (MRI), an infarction was observed in the right middle cerebral artery, and on cranial MR angiography, a thrombus was detected at the level of the right middle cerebral artery M2-3. Thrombolytic therapy was initiated 90 minutes after the onset of the first symptoms. No maternal or fetal problems were detected. The patient had a Modified Rankin Score of 0 at 3 months. We administered IV tPA treatment to the pregnant patient who presented with severe stroke symptoms considering the benefits outweighed the risks.

 First trimester pregnancy thrombolytic therapy First trimester pregnancy thrombolytic therapy Swartz RH, Cayley ML, Foley N, Ladhani NNN, Leffert L, Bushnell C, McClure JA, Lindsay MP. The incidence of pregnancy-related stroke: A systematic review and meta-analysis. Int J Stroke. 2017;12(7):687-697. doi:10.1177/1747493017712427. Singhal AB, Biller J, Elkind MS, Fullerton HJ, Jauch EC, Kittner SJ, Levine DA, Levine SR. Recognition and management of stroke in young adults and adolescents. Neurology. 2013;81(12):1089-1097. doi:10.1212/WNL.0b013e3182a4a451. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B. 2018 guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49(3):e46-e99. doi:10.1161/STR.0000000000000158. Ladhani NNN, Swartz RH, Foley N, Nerenberg K, Smith EE, Gubitz G, Dowlatshahi D, Potts J, Ray JG, Barrett J. Canadian stroke best practice consensus statement: Acute stroke management during pregnancy. Int J Stroke. 2018;13(7):743-758. doi:10.1177/1747493018786617. Demaerschalk BM, Kleindorfer DO, Adeoye OM, Demchuk AM, Fugate JE, Grotta JC, Khalessi AA, Levy EI, Palesch YY, Prabhakaran S, Saposnik G, Saver JL, Smith EE. Scientific rationale for the inclusion and exclusion criteria for intravenous alteplase in acute ischemic stroke: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2016;47(2):581-641. doi:10.1161/STR.0000000000000086. Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, Khatri P, McMullan PW Jr, Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H. Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870-947. doi:10.1161/STR.0b013e318284056a. Kremer C, Gdovinova Z, Bejot Y, Heldner MR, Zuurbier S, Walter S, Lal A, Epple C, Lorenzano S, Mono ML, Karapanayiotides T, Krishnan K, Jovanovic D, Dawson J, Caso V. European Stroke Organisation guidelines on stroke in women: Management of menopause, pregnancy and postpartum. Eur Stroke J. 2022;7(1):I-XIX. doi:10.1177/23969873221075000. Uy CE, Gosselin-Lefebvre S, Book AM, Field TS. Reperfusion therapy for acute stroke in pregnant and postpartum women: A Canadian survey. Can J Neurol Sci. 2021;48(3):344-348. doi:10.1017/cjn.2020.202. Richardt A, Aarnio K, Korhonen A, Rantanen K, Verho L, Curtze S, Laivuori H, Gissler M, Tikkanen M, Ijäs P. Acute recanalization therapy for ischemic stroke during pregnancy and puerperium. J Neurol. 2024. doi:10.1007/s00415-023-12068-4. Leffert LR, Clancy CR, Bateman BT, Cox M, Schulte PJ, Smith EE, Fonarow GC, Kuklina EV, George MG, Schwamm LH. Treatment patterns and short-term outcomes in ischemic stroke in pregnancy or postpartum period. Am J Obstet Gynecol. 2016;214(6):723.e1-723.e11. doi:10.1016/j.ajog.2015.12.045. Béjot Y, Olié V, Lailler G, Grave C, Regnault N, Blacher J, Duloquin G, Gabet A. Acute revascularization therapy for ischemic stroke during pregnancy and postpartum in France. Eur Stroke J. 2023;8(2):467-474. doi:10.1177/23969873231171500. Karjalainen L, Tikkanen M, Rantanen K, Laivuori H, Gissler M, Ijäs P. Pregnancy-associated stroke—a systematic review of subsequent pregnancies and maternal health. BMC Pregnancy Childbirth. 2019;19(1):187. doi:10.1186/s12884-019-2340-5. Committee opinion no. 723: Guidelines for diagnostic imaging during pregnancy and lactation. Obstet Gynecol. 2017;130(4):e210-e216. doi:10.1097/AOG.0000000000002355. Wiącek M, Oboz-Adaś A, Kuźniar K, Karaś A, Jasielski P, Bartosik-Psujek H. Acute ischemic stroke in pregnancy. Clin Neuroradiol. 2023;33(1):31-39. doi:10.1007/s00062-022-01189-4.