Unexpected Outcomes of Intravenous Thrombolysis in Aortic Dissection

Overview

This case study presents an 87-year-old woman who experienced acute ischemic stroke due to acute aortic dissection and received intravenous thrombolysis. The report highlights the complications arising from thrombolysis in this context, including delayed surgical intervention and subsequent neurological deterioration.

Background

Acute aortic dissection (AAD) is a critical cardiovascular emergency that can lead to severe complications, including ischemic stroke. The inappropriate use of intravenous thrombolysis (IVT) in patients presenting with acute ischemic stroke due to AAD poses significant risks, including potential hemorrhagic complications. Understanding the management of such cases is essential for improving patient outcomes and minimizing adverse effects.

Data Highlights

Key Findings

• Intravenous thrombolysis was administered to a patient with acute ischemic stroke due to aortic dissection, despite contraindications.
• Post-thrombolysis imaging revealed expansion of cerebral infarction and new infarctions in the brain.
• Delayed surgical intervention was necessitated due to concerns about thrombolysis-related bleeding risks.
• The patient exhibited significant blood pressure asymmetry, indicative of aortic dissection complications.
• Postoperative findings included a 3 cm-long intimal tear in the ascending aorta and a gelatinous mural thrombus.

Clinical Implications

Healthcare professionals should be cautious when considering thrombolysis in patients with suspected aortic dissection presenting as acute ischemic stroke. Rapid assessment and imaging are critical to avoid inappropriate treatment that may lead to severe complications. Multidisciplinary approaches are essential for managing such complex cases effectively.

Conclusion

This case underscores the risks associated with intravenous thrombolysis in the context of acute aortic dissection and highlights the importance of timely surgical intervention. Enhanced awareness and adherence to guidelines can improve patient safety and outcomes.

References

1. Evaluation of Emergency Interventions for Acute Thrombosis in STA-MCA Bypass Surgery, 2024 -- Review of Existing Literature
2. Evaluation of Immediate Versus Delayed Stenting Following Thrombectomy Failure, 2025 -- Patients with Intracranial Atherosclerosis-Induced Large Vessel Occlusion
3. Endovascular Recanalization with Distal Protection for Symptomatic Chronic Occlusions of the Vertebrobasilar Artery, 2025
4. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update, American Heart Association/American Stroke Association
5. 2024 ESC Guidelines for Peripheral Arterial and Aortic Diseases
6. Endovascular Recanalization through the Ascending Cervical Artery for Occlusion of Non-Conical Stump Vertebral Artery: A Case Study
7. https://www.escardio.org/static-file/Escardio/Guidelines/Products/Essential%20Messages/2024%20EM/Essential%20Messages_2024%20PAAD.pdf
8. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association
9. https://j-stroke.org/upload/pdf/jos-2024-02915.pdf