Early recurrent ischemic stroke involving the independent carotid territory after intravenous thrombolysis: A case report and literature review

Early recurrent ischemic stroke (ERIS) in stroke patients receiving intravenous thrombolysis (IVT) is an easily overlooked complication. A 73-year-old female patient presented with acute left hemiplegia due to right middle cerebral artery occlusion. 40 min after IVT, an episode of neurological decline was noted before the mechanical thrombectomy (MT). Occlusion of the left internal carotid artery was unveiled on the follow-up angiogram of MT. ERIS could occur after IVT, especially for those with early neurological deterioration. We suggest keeping high clinical suspicion and repeating computed tomography angiography in these patients to provide the appropriate therapeutic strategy.