JACC. Case reports · 2026
Balancing Ischemia and Hemorrhage After Tenecteplase in Wake-Up Stroke.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Luna-Alcala Santiago, Acosta Gutiérrez Gilberto Hiram, Peña-Cabral Marco Antonio, Herrera-Gomar Magali, Flores Aldama Marco Julio
Аннотация
BACKGROUND: Contemporary stroke management assumes discrete clinical scenarios with clear separation between ischemic and hemorrhagic risks. When these processes coexist, guideline recommendations may be insufficient or conflicting.
CASE SUMMARY: A 74-year-old woman with a wake-up stroke received computed tomography perfusion-guided thrombolysis. She developed hemorrhagic transformation, followed by intermediate-risk pulmonary embolism (PE) requiring anticoagulation. Despite treatment, recurrent intracranial large-vessel occlusion occurred; mechanical thrombectomy achieved complete reperfusion. Transesophageal echocardiography revealed a thrombus traversing a patent foramen ovale, confirming paradoxical embolism. WHY BEYOND THE GUIDELINES?: Management required balancing competing thrombotic and hemorrhagic risks: anticoagulation for PE after hemorrhagic transformation and thrombectomy in a recently thrombolyzed brain.
DISCUSSION: Overlapping thrombotic and hemorrhagic conditions require individualized decision-making guided by continuous risk reassessment and multidisciplinary collaboration.
TAKE-HOME MESSAGES: Concurrent stroke, PE, and hemorrhagic transformation create conflicting recommendations requiring dynamic decision-making. A thrombus crossing a patent foramen ovale confirms paradoxical embolism and justifies aggressive intervention.
CASE SUMMARY: A 74-year-old woman with a wake-up stroke received computed tomography perfusion-guided thrombolysis. She developed hemorrhagic transformation, followed by intermediate-risk pulmonary embolism (PE) requiring anticoagulation. Despite treatment, recurrent intracranial large-vessel occlusion occurred; mechanical thrombectomy achieved complete reperfusion. Transesophageal echocardiography revealed a thrombus traversing a patent foramen ovale, confirming paradoxical embolism. WHY BEYOND THE GUIDELINES?: Management required balancing competing thrombotic and hemorrhagic risks: anticoagulation for PE after hemorrhagic transformation and thrombectomy in a recently thrombolyzed brain.
DISCUSSION: Overlapping thrombotic and hemorrhagic conditions require individualized decision-making guided by continuous risk reassessment and multidisciplinary collaboration.
TAKE-HOME MESSAGES: Concurrent stroke, PE, and hemorrhagic transformation create conflicting recommendations requiring dynamic decision-making. A thrombus crossing a patent foramen ovale confirms paradoxical embolism and justifies aggressive intervention.