{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T05:06:01Z","timestamp":1770354361388,"version":"3.49.0"},"reference-count":34,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"15","license":[{"start":{"date-parts":[[2021,4,12]],"date-time":"2021-04-12T00:00:00Z","timestamp":1618185600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,4,12]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Intravenous tissue plasminogen activator (IV t-PA) is effective for the treatment of distal artery occlusion. However, after the use of IV t-PA, vascular occlusion in unaffected territories may occur. Early recurrent ischemic stroke (ERIS) is defined as the occurrence of new neurological symptoms that suggest the involvement of initially unaffected vascular territories after intravenous thrombolysis (IVT). The authors reviewed the cases of ERIS that occurred within 24 hours after treatment with IVT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 75-year-old woman with occlusion in the M2 segment of the left middle cerebral artery (MCA) was treated with IV t-PA. However, 360 minutes later, the patient presented with occlusion in the M1 distal segment of the contralateral side, the right MCA, which was recanalized by endovascular treatment. Her modified Rankin Scale score was 4; however, aphasia was not observed. She was transferred to a rehabilitation hospital after 3 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>ERIS is an extremely rare but catastrophic event. The underlying mechanism of ERIS most likely involves the disintegration and subsequent scattering of a preexisting intracardiac thrombus. Hence, caution must be used when managing not only hemorrhagic complications but also ischemic complications after IV t-PA. Endovascular management may be the only effective treatment for this type of large vessel occlusion.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case20175","type":"journal-article","created":{"date-parts":[[2021,5,4]],"date-time":"2021-05-04T15:53:37Z","timestamp":1620143617000},"source":"Crossref","is-referenced-by-count":0,"title":["Vascular occlusion in a previously unaffected territory after treatment with intravenous plasminogen activator: illustrative case"],"prefix":"10.3171","volume":"1","author":[{"given":"Akira","family":"Sugie","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"Emergency Medical Center, Ijinkai Takeda General Hospital, Kyoto, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Makoto","family":"Yamada","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kunio","family":"Yokoyama","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomoaki","family":"Miyake","sequence":"additional","affiliation":[{"name":"Neurology, Ijinkai Takeda General Hospital, Kyoto, Japan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yutaka","family":"Ito","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hidekazu","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yukiya","family":"Nomura","sequence":"additional","affiliation":[{"name":"Emergency Medical Center, Ijinkai Takeda General Hospital, Kyoto, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masutsugu","family":"Fujita","sequence":"additional","affiliation":[{"name":"Emergency Medical Center, Ijinkai Takeda General Hospital, Kyoto, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshio","family":"Nakatani","sequence":"additional","affiliation":[{"name":"Emergency Medical Center, Ijinkai Takeda General Hospital, Kyoto, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahiro","family":"Kawanishi","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"10","key":"b1","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"2254","DOI":"10.1161\/STROKEAHA.110.592535","article-title":"Low rates of acute recanalization with intravenous recombinant tissue plasminogen activator in ischemic stroke: real-world experience and a call for action","volume":"41","author":"Bhatia\n \nR","year":"2010","unstructured":"Bhatia\n \nR\n\n, \n\nHill\n \nMD\n\n, \n\nShobha\n \nN\n\n, \n\n\n. \nLow rates of acute recanalization with intravenous recombinant tissue plasminogen activator in ischemic stroke: real-world experience and a call for action\n. \nStroke\n. \n2010\n;\n41\n(\n10\n):\n2254\n\u2013\n2258\n.\n10.1161\/STROKEAHA.110.592535"},{"issue":"7","key":"b2","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1662","DOI":"10.1161\/STROKEAHA.118.020567","article-title":"Beyond large vessel occlusion strokes: distal occlusion thrombectomy","volume":"49","author":"Grossberg\n \nJA","year":"2018","unstructured":"Grossberg\n \nJA\n\n, \n\nRebello\n \nLC\n\n, \n\nHaussen\n \nDC\n\n, \n\n\n. \nBeyond large vessel occlusion strokes: distal occlusion thrombectomy\n. \nStroke\n. \n2018\n;\n49\n(\n7\n):\n1662\n\u2013\n1668\n.\n10.1161\/STROKEAHA.118.020567"},{"issue":"3","key":"b3","series-title":"Circulation","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1161\/CIRCULATIONAHA.105.597435","article-title":"Early recurrent ischemic stroke in stroke patients undergoing intravenous thrombolysis","volume":"114","author":"Georgiadis\n \nD","year":"2006","unstructured":"Georgiadis\n \nD\n\n, \n\nEngelter\n \nS\n\n, \n\nTettenborn\n \nB\n\n, \n\n\n. \nEarly recurrent ischemic stroke in stroke patients undergoing intravenous thrombolysis\n. \nCirculation\n. \n2006\n;\n114\n(\n3\n):\n237\n\u2013\n241\n.\n10.1161\/CIRCULATIONAHA.105.597435"},{"issue":"6","key":"b4","series-title":"Jpn J Stroke","doi-asserted-by":"publisher","first-page":"441","DOI":"10.3995\/jstroke.10483","article-title":"One instance of a patient with brain embolism occurring in the contralateral middle cerebral artery during the t-PA intravenous injection. 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