Undisclosed Abdominal Aortic Aneurysm as a Risk Factor for Hemorrhage in Tenecteplase Stroke Thrombolysis: A Case Report
Abstract
Patient: Male, 77-year-old Final Diagnosis: Delayed ICH post-TNK thrombolysis in ischemic stroke with AAA Symptoms: Left-sided weakness • groin pain • blood pressure asymmetry • rapid neurological deterioration Clinical Procedure: — Specialty: Neurology Objective: Rare coexistence of disease or pathology Background Tenecteplase (TNK), a recombinant tissue plasminogen activator administered as a single intravenous bolus, is increasingly used in acute ischemic stroke (AIS) thrombolysis owing to its ease of administration and comparable efficacy to alteplase. Patients with AIS often have cardiovascular comorbidities, including coronary atherosclerosis and aortic disease, which can predispose to abdominal aortic aneurysm (AAA). This report presents the case of a 77-year-old man treated with TNK fibrinolysis for AIS, in whom an incidental AAA was later identified, highlighting its potential impact on hemorrhagic risk. Case Report A 77-year-old man presented 4 h after onset of acute left-sided weakness, with a National Institutes of Health Stroke Scale score of 12. Initial head computed tomography (CT) excluded hemorrhage, and intravenous TNK (0.25 mg/kg, 21.25 mg) was administered, resulting in partial neurological improvement. Several hours later, he developed groin pain, diaphoresis, and hemodynamic instability. Aortic CT angiography revealed an infrarenal AAA measuring 41 mm, with mural thrombus and penetrating ulceration. The AAA had been previously noted as measuring 34 mm…
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