Off-label Use of Intravenous Thrombolysis in an Acute Ischemic Stroke Patient With Multiple Contraindications

Introduction: Intravenous thrombolysis (IVT) is a powerful treatment for acute ischemic stroke, yet its use remains limited due to numerous absolute and relative contraindications. Case Report: We present the case of a 54-year-old man who received intravenous thrombolysis (IVT) for an early recurrent wake-up ischemic stroke caused by a tandem left internal carotid artery and M2 middle cerebral artery occlusion, occurring <48 hours after the initial ischemic event, which had been misdiagnosed as a peripheral-type facial nerve palsy. Moreover, in the context of the initial work-up, the patient had undergone a diagnostic lumbar puncture <24 hours before IVT. Despite the history of a very recent acute ischemic stroke, which is listed as a contraindication for IVT, as well as the recent lumbar puncture, the patient demonstrated marked clinical improvement without any complications. Conclusion: IVT may be considered even in the presence of multiple relative contraindications, provided the risks and benefits are carefully weighed for each patient.