{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T16:15:31Z","timestamp":1779207331252,"version":"3.51.4"},"reference-count":12,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"38","license":[{"start":{"date-parts":[[2019,9,1]],"date-time":"2019-09-01T00:00:00Z","timestamp":1567296000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"Abstract<\/jats:title>\n \n Rationale:<\/jats:title>\n The regimen of the recombinant tissue plasminogen activator (rt-PA) is identical in every case where it is indicated in the treatment of cerebral infarction. We report a case of efficient recanalization of large arterial occlusion after rapid injection of rt-PA.<\/jats:p>\n <\/jats:sec>\n \n Patient concerns:<\/jats:title>\n A 78-year-old man was admitted with right-sided hemiplegia and global aphasia that occurred an hour ago.<\/jats:p>\n <\/jats:sec>\n \n Diagnoses:<\/jats:title>\n His brain computed tomography (CT) revealed no hemorrhage, suggesting cerebral infarction.<\/jats:p>\n <\/jats:sec>\n \n Interventions:<\/jats:title>\n Ten percent of a total rt-PA dose was injected over 1 minute promptly. The remainder of rt-PA was designed to be infused for 60 minutes. Unexpectedly, during the study of CT angiography, administration of rt-PA was completed within 5 minutes. CT angiography showed occlusion from carotid bifurcation to the middle cerebral artery.<\/jats:p>\n <\/jats:sec>\n \n Outcomes:<\/jats:title>\n After 2\u200ahours of rt-PA administration, the patient began to regain strength in his right arm and leg. By the next day, he had only mild dysarthria and aphasia. Follow-up CT angiography revealed recanalized internal cervical artery and severe residual stenosis with a plaque. He was discharged without any neurologic symptoms.<\/jats:p>\n <\/jats:sec>\n \n Lessons:<\/jats:title>\n The infusion protocol of rt-PA administration is established in 1995 and has not changed. Successful recanalization of long segmental large vessel occlusion with only intravenous rt-PA is relatively low. In our case, a high concentration of rt-PA may have influenced the successful dissemination of large thrombus in the whole internal cervical artery. Our case is of significance as it raises the question of unanswered efficacy of diverse injection protocol according to thrombus size and bleeding risk.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/md.0000000000017331","type":"journal-article","created":{"date-parts":[[2019,9,30]],"date-time":"2019-09-30T23:53:56Z","timestamp":1569887636000},"page":"e17331","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Dramatic thrombolysis after rapid injection of tissue plasminogen activator"],"prefix":"10.1097","volume":"98","author":[{"given":"Jin-Sung","family":"Park","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaechun","family":"Hwang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2019,9]]},"reference":[{"key":"R1-20260519","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1056\/NEJM199512143332401","article-title":"Tissue plasminogen activator for acute ischemic stroke","volume":"333","year":"1995","journal-title":"N Engl J Med"},{"key":"R2-20260519","doi-asserted-by":"crossref","first-page":"2409","DOI":"10.1161\/STROKEAHA.116.014181","article-title":"Incidence and predictors of early recanalization after intravenous thrombolysis: a systematic review and meta-analysis","volume":"47","author":"Seners","year":"2016","journal-title":"Stroke"},{"key":"R3-20260519","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1056\/NEJMoa0804656","article-title":"Thrombolysis with alteplase 3 to 4.5\u200ahours after acute ischemic stroke","volume":"359","author":"Hacke","year":"2008","journal-title":"N Engl J Med"},{"key":"R4-20260519","doi-asserted-by":"crossref","first-page":"e46","DOI":"10.1161\/STR.0000000000000158","article-title":"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","volume":"49","author":"Powers","year":"2018","journal-title":"Stroke"},{"key":"R5-20260519","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1056\/NEJMoa1804355","article-title":"MRI-guided thrombolysis for stroke with unknown time of onset","volume":"379","author":"Thomalla","year":"2018","journal-title":"N Engl J Med"},{"key":"R6-20260519","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1161\/01.STR.0000258112.14918.24","article-title":"The impact of recanalization on ischemic stroke outcome: a meta-analysis","volume":"38","author":"Rha","year":"2007","journal-title":"Stroke"},{"key":"R7-20260519","doi-asserted-by":"crossref","first-page":"2066","DOI":"10.1161\/01.STR.0000021001.18101.A5","article-title":"Clinical and vascular outcome in internal carotid artery versus middle cerebral artery occlusions after intravenous tissue plasminogen activator","volume":"33","author":"Linfante","year":"2002","journal-title":"Stroke"},{"key":"R8-20260519","doi-asserted-by":"crossref","first-page":"2529","DOI":"10.1161\/01.STR.29.12.2529","article-title":"Thrombolysis with intravenous rtPA in a series of 100 cases of acute carotid territory stroke: determination of etiological, topographic, and radiological outcome factors","volume":"29","author":"Trouillas","year":"1998","journal-title":"Stroke"},{"key":"R9-20260519","doi-asserted-by":"crossref","first-page":"2275","DOI":"10.1161\/STROKEAHA.106.480475","article-title":"Risk factors of symptomatic intracerebral hemorrhage after tPA therapy for acute stroke","volume":"38","author":"Lansberg","year":"2007","journal-title":"Stroke"},{"key":"R10-20260519","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1002\/ana.21222","article-title":"Risk for symptomatic intracerebral hemorrhage after thrombolysis assessed by diffusion-weighted magnetic resonance imaging","volume":"63","author":"Singer","year":"2008","journal-title":"Ann Neurol"},{"key":"R11-20260519","doi-asserted-by":"crossref","first-page":"2313","DOI":"10.1056\/NEJMoa1515510","article-title":"Low-dose versus standard-dose intravenous alteplase in acute ischemic stroke","volume":"374","author":"Anderson","year":"2016","journal-title":"N Engl J Med"},{"key":"R12-20260519","doi-asserted-by":"crossref","first-page":"69","DOI":"10.3389\/fneur.2013.00069","article-title":"Hemorrhagic transformation: a review of the rate of hemorrhage in the major clinical trials of acute ischemic stroke","volume":"4","author":"Sussman","year":"2013","journal-title":"Front Neurol"}],"container-title":["Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/MD.0000000000017331","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T16:01:15Z","timestamp":1779206475000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/MD.0000000000017331"}},"subtitle":["A case report"],"short-title":[],"issued":{"date-parts":[[2019,9]]},"references-count":12,"journal-issue":{"issue":"38","published-online":{"date-parts":[[2019]]}},"URL":"https:\/\/doi.org\/10.1097\/md.0000000000017331","relation":{},"ISSN":["0025-7974","1536-5964"],"issn-type":[{"value":"0025-7974","type":"print"},{"value":"1536-5964","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,9]]},"assertion":[{"value":"2019-04-20","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-09-02","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}