Endovascular thrombectomy and left atrial appendage evaluation for recurrent cerebral embolism case with atrial fibrillation early after administration of intravenous tissue plasminogen activator

Recurrent ischemic stroke early after administration of intravenous tissue plasminogen activator (IV t-PA) is a rare complication. Most previously reported cases have shown poor prognosis with only speculations regarding reasons for recurrence. We report a case of recurrent cerebral infarction due to atrial fibrillation early after IV t-PA in a 77-year-old woman. She presented with sudden neurological deterioration 86 min after IV t-PA. Magnetic resonance imaging demonstrated new ischemic stroke with right internal carotid artery occlusion. Endovascular thrombectomy improved her prognosis and we evaluated the left atrial appendage using transesophageal echocardiography. Attention should be paid to ischemic stroke recurrence as a complication of IV t-PA, and preparation for mechanical thrombectomy is warranted. Further study of the left atrial appendage is needed to clarify the mechanisms of onset.