{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:39:46Z","timestamp":1791477586876,"version":"4.3.4"},"reference-count":18,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2011,8]]},"abstract":"<jats:p>Stroke patients whose condition does not improve after intravenous administration of tissue plasminogen activator (tPA) may be candidates for endovascular intervention. Patients with new intracerebral hemorrhage noted during such interventions pose a difficult challenge to neurointerventionists and are often sequestered as treatment failures and deemed inappropriate for intraarterial recanalization efforts. The authors present a case in which aggressive intervention was performed despite evidence of contrast extravasation on preintervention angiography. This 37-year-old woman presented with an occlusion of the M<jats:sub>1<\/jats:sub> segment of the left middle cerebral artery and a National Institutes of Health Stroke Scale score of 24. She received intravenous tPA without improvement. Angiography revealed M<jats:sub>1<\/jats:sub> thrombus as well as active contrast extravasation without arterial displacement. Thromboaspiration was performed in light of her known hemorrhage with excellent recanalization. Immediate postprocedure imaging demonstrated a large insular hematoma and emergent craniectomy and hematoma evacuation were performed. At 4 months' follow-up, the patient was living at home, was ambulating, and had excellent comprehension with mild expressive aphasia. There is little peer-reviewed data in the literature to aid in the decision-making process when contrast extravasation is recognized at the time of preinterevention angiography. Continuation of mechanical endovascular stroke intervention, in light of active contrast extravasation, may be warranted in young patients with major deficits and absence of arterial displacement or delayed global filling. Further thrombolytics are not advised. In select stroke patients, continuation of a planned attempt at mechanical recanalization without the further use of thrombolytics may be warranted in light of known intracerebral hemorrhage.<\/jats:p>","DOI":"10.3171\/2011.3.jns101514","type":"journal-article","created":{"date-parts":[[2011,4,15]],"date-time":"2011-04-15T18:39:11Z","timestamp":1302892751000},"page":"359-363","source":"Crossref","is-referenced-by-count":4,"title":["Aggressive intervention to treat a young woman with intracranial hemorrhage following unsuccessful intravenous thrombolysis for left middle cerebral artery occlusion"],"prefix":"10.3171","volume":"115","author":[{"given":"Kyle M.","family":"Fargen","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian L.","family":"Hoh","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory L.","family":"Fautheree","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter R.","family":"Morgan","sequence":"additional","affiliation":[{"name":"Neurology and Neurosciences, University of Florida, College of Medicine, Gainesville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory J.","family":"Velat","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael F.","family":"Waters","sequence":"additional","affiliation":[{"name":"Neurology and Neurosciences, University of Florida, College of Medicine, Gainesville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Mocco","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns101514","series-title":"Stroke","first-page":"847","article-title":"Stent placement in acute cerebral artery occlusion: use of a self-expandable intracranial stent for acute stroke treatment","volume":"40","author":"Brekenfeld","year":"2009"},{"key":"b2-jns101514","series-title":"Stroke","first-page":"811","article-title":"The rtPA (alteplase) 0- to 6-hour acute stroke trial, part A (A0276g): results of a double-blind, placebo-controlled, multicenter study. Thromblytic therapy in acute ischemic stroke study investigators","volume":"31","author":"Clark","year":"2000"},{"key":"b3-jns101514","series-title":"Stroke","first-page":"1274","article-title":"Mechanical thrombectomy of intracranial internal carotid occlusion: pooled results of the MERCI and Multi MERCI Part I trials","volume":"38","author":"Flint","year":"2007"},{"key":"b4-jns101514","series-title":"JAMA","first-page":"2003","article-title":"Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism","volume":"282","author":"Furlan","year":"1999"},{"key":"b5-jns101514","series-title":"Lancet","first-page":"768","article-title":"Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials","volume":"363","author":"Hacke","year":"2004"},{"key":"b6-jns101514","series-title":"JAMA","first-page":"1017","article-title":"Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke","volume":"274","author":"Hacke","year":"1995"},{"key":"b7-jns101514","series-title":"Lancet","first-page":"1245","article-title":"Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II)","volume":"352","author":"Hacke","year":"1998"},{"key":"b8-jns101514","series-title":"Stroke","first-page":"2127","article-title":"The Interventional Management of Stroke (IMS) II Study","volume":"38","author":"IMS II Trial Investigators","year":"2007"},{"key":"b9-jns101514","series-title":"Lancet","first-page":"1695","article-title":"Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials","volume":"375","author":"Lees","year":"2010"},{"key":"b10-jns101514","series-title":"Neurosurgery","first-page":"458","article-title":"Stent-assisted intracranial recanalization for acute stroke: early results","volume":"58","author":"Levy","year":"2006"},{"key":"b11-jns101514","series-title":"AJNR Am J Neuroradiol","first-page":"816","article-title":"Self-expanding stents for recanalization of acute cerebrovascular occlusions","volume":"28","author":"Levy","year":"2007"},{"key":"b12-jns101514","series-title":"Stroke","first-page":"3552","article-title":"First Food and Drug Administration-approved prospective trial of primary intracranial stenting for acute stroke: SARIS (stent-assisted recanalization in acute ischemic stroke)","volume":"40","author":"Levy","year":"2009"},{"key":"b13-jns101514","series-title":"J Neurosurg","first-page":"30","article-title":"Endovascular intervention for acute thromboembolic stroke in young patients: an ideal population for aggressive intervention? Clinical article","volume":"110","author":"Mocco","year":"2009"},{"key":"b14-jns101514","series-title":"N Engl J Med","first-page":"1581","article-title":"Tissue plasminogen activator for acute ischemic stroke","volume":"333","author":"The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group","year":"1995"},{"key":"b15-jns101514","series-title":"Stroke","first-page":"2761","article-title":"The penumbra pivotal stroke trial: safety and effectiveness of a new generation of mechanical devices for clot removal in intracranial large vessel occlusive disease","volume":"40","author":"Penumbra Pivotal Stroke Trial Investigators","year":"2009"},{"key":"b16-jns101514","series-title":"J Cereb Blood Flow Metab","first-page":"1905","article-title":"Factors affecting the apparent efficacy and safety of tissue plasminogen activator in thrombotic occlusion models of stroke: systematic review and meta-analysis","volume":"30","author":"Sena","year":"2010"},{"key":"b17-jns101514","series-title":"Stroke","first-page":"1205","article-title":"Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial","volume":"39","author":"Smith","year":"2008"},{"issue":"4","key":"b18-jns101514","series-title":"Cochrane Database Syst Rev","first-page":"CD000213","article-title":"Thrombolysis for acute ischaemic stroke","author":"Wardlaw","year":"2009"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/115\/2\/article-p359.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/115\/2\/article-p359.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/115\/2\/article-p359.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T02:57:12Z","timestamp":1679885832000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/115\/2\/article-p359.xml"}},"subtitle":["Case report"],"short-title":[],"issued":{"date-parts":[[2011,8]]},"references-count":18,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2011.3.jns101514","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,8]]}}}