Practical Pearls

Neurocritical Care

, Volume 2, Issue 2, pp 179-182

First online:

Intra-arterial thrombolysis of a distal internal carotid artery occlusion in an adolescent

  • Eric C. BourekasAffiliated withDepartment of Radiology, The Ohio State University Medical Center Email author 
  • , Andrew P. SlivkaAffiliated withDepartment of Neurology, The Ohio State University College of Medicine
  • , Marcel J. CasavantAffiliated withDepartment of Pediatrics and Emergency Medicine, Children’s Hospital

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Introduction: This article describes the first reported case of an adolescent being treated with intra-arterial urokinase for a distal internal carotid artery occlusion.

Methods: A 15-year-old male presenting with an acute ischemic stroke caused by a distal internal carotid artery occlusion was treated with intra-arterial urokinase at 5 hours and 45 minutes after symptom onset.

Results: The artery completely recanalized, and the patient improved significantly from an admission National Institutes of Health Stroke Scale (NIHSS) score of 28 to a NIHSS score of 8 at a 2.5-month follow-up, despite an asymptomatic intraparenchymal hemorrhage.

Conclusion: This article reviews the only two reported cases of intravenous thrombolysis and three cases of intra-arterial thrombolysis in children with ischemic stroke and suggests that thrombolytic therapy should be considered a treatment option in selected pediatric patients with stroke, especially in adolescents who are generally treated as young adults.

Key Words

Thrombolysis intra-arterial pediatric urokinase stroke