30
General Supportive Early Management
Table 6. Other Situations Wherein Thrombolysis is Deemed
to be Considered
Conditions in which benefits of intravenous thrombolysis generally are
greater than risks of bleeding
Extracranial
cervical
dissections
IV thrombolysis in AIS known or suspected to be associated with
extracranial cervical arterial dissection is reasonably safe within
4.5 h and probably recommended.
Extra-axial
intracranial
neoplasms
e risk of harm of IV thrombolysis in patients with AIS and extra-
axial intracranial neoplam is likely low. Benefit likely outweighs risk
in this population and IV thrombolysis should be considered.
Angiographic
procedural stroke
IV thrombolysis in patients with AIS during or immediately post-
angiography should be considered as benefit likely outweighs risk
in this population.
Unruptured
intracranial
aneurysm
The risk of harm of IV thrombolysis in patients with AIS
and unruptured intracranial aneurysm is likely low. Benefit
likely outweighs risk in this population and treatment with IV
thrombolysis should be considered.
History of GI/
GU bleeding
IV thrombolysis in AIS patients with previous remote history
of GI or GU bleeding that is stable may be candidates for IV
thrombolysis. Consideration of benefit and risk on an individual
basis in conjunction with GI or GU consultation is appropriate.
History of MI IV thrombolysis in AIS patients with remote history of MI
probably has greater benefit than risk.
Recreational drug
use
IV thrombolysis in AIS patients with known recreational drug use
probably has greater benefit than risk in most patients and should
be considered.
Uncertainty of
stroke diagnosis/
stroke mimics
When uncertain if a patient is presenting with symptoms due to
stroke vs a stroke mimic, unless there are absolute contraindications,
the risk of harm with IV thrombolysis is low. The benefit of IV
thrombolysis likely outweighs risk in these patients.
Moya-Moya IV thrombolysis in AIS patients with Moya-Moya disease does not
appear to have an increased risk of ICH and likely provides benefit
that outweighs risk.
