TRANSIENT CARDIOVASCULAR INSTABILITY DURING INTRAVENOUS THROMBOLYTIC THERAPY IN ACUTE ISCHEMIC STROKE – CASE REPORT

Authors

Eleni Krasnikova
Aikaterini Theodorou
Vassiliki Peteinelli-Kotsali
Georgia Kaloudi
Maria Maili
Maria Chondrogianni
Chryssa Arvaniti
Konstantinos Melanis
Ioanna Tsantzali
Georgia Papagiannopoulou
Georgios Tsivgoulis
Eleni Bakola

Keywords:

cerebral infarction, alteplase, bradykinin, hemodynamic instability

Abstract

A 59-year-old woman on antihypertensive treatment with Angiotensin-Converting-Enzyme (ACE) inhibitor
was transferred to our hospital with acute onset dysarthria and left hemiparesis due to acute ischemic
stroke. Before the end of treatment with intravenous alteplase infusion, she developed transient bradycardia
with subsequent severe hypotension without orolingual angioedema and was treated successfully with
fluids and vasopressors without any neurological deterioration. Transient hemodynamic instability during
or right after alteplase treatment in acute ischemic stroke patients pretreated with ACE inhibitors may be
caused by vasodilatation due to bradykinin accumulation induced by tissue plasminogen activator. This very
uncommon complication may also be accompanied by orolingual angioedema. The present case report
highlights potential underlying mechanisms and suggested approaches.