Safety of thrombolysis in acute ischemic stroke patients with previous aortic abdominal aneurysm repair.
Publication Title
J Stroke Cerebrovasc Dis
Document Type
Article
Publication Date
10-1-2025
Keywords
texas; covenant
Abstract
OBJECTIVE: Intravenous thrombolysis is the standard treatment for acute ischemic stroke (AIS), but its safety in patients with a history of abdominal aortic aneurysm (AAA) repair remains unclear. Many contraindications for thrombolysis stem from populations excluded in pivotal clinical trials, leaving uncertainty about the risk of AAA repair rupture. This study aims to assess the safety of intravenous thrombolysis in AIS patients with prior AAA repair.
METHODS: This is a retrospective study of patients with a prior history of AAA repair who received intravenous thrombolysis for AIS between 2013 and 2023. Data collected included demographic and clinical characteristics, details of aneurysm repair, abdominal computed tomography angiography (CTA), and patient outcomes.
RESULTS: Sixteen patients with a history of AAA repair who received intravenous thrombolysis for AIS were included. The median age was 86.5 years (IQR 80.8-89.8). Most patients (92.3 %) had undergone endovascular repair, with a median time of 10 years (IQR 4.4-14.8) between AAA repair and thrombolysis. No patients underwent abdominal CTA prior to thrombolysis; two patients had post-thrombolysis CTA, both revealing endoleaks, one of which led to aneurysm rupture. Only one patient (6 %) experienced AAA rupture post-thrombolysis. The median mRS was 3 (IQR 1.8-4) at three months.
CONCLUSIONS: The incidence of AAA rupture after thrombolytic therapy in patients with prior repair was low. Larger studies are needed to determine whether rapid abdominal CTA could identify high-risk features and prevent life-threatening complications.
Area of Special Interest
Neurosciences (Brain & Spine)
Area of Special Interest
Cardiovascular (Heart)
Specialty/Research Institute
Neurosciences
Specialty/Research Institute
Cardiology
DOI
10.1016/j.jstrokecerebrovasdis.2025.108421
