Cardiac Rupture and Death Following Administration of Recombinant Tissue-Type Plasminogen Activator (rt-PA).

Administration of recombinant tissue-type plasminogen activator (rt-PA) in the hyperacute phase of ischemic stroke is fraught with various pitfalls. An 81-year-old man had a stroke with aphasia and right incomplete paralysis, and CT angiography showed occlusion of the left internal carotid artery (ICA) within two hours of onset. The stroke neurologist administered rt-PA and started endovascular treatment, but during the treatment, the patient went into cardiopulmonary arrest without warning and died despite resuscitation. Autopsy revealed that the cause of death was cardiac rupture due to subacute myocardial infarction in the left ventricular lateral wall. In the administration of rt-PA to patients with hyperacute cerebral infarction, special consideration should be given not only to eligibility criteria for rt-PA administration but also to screening for comorbidities.