Embolization of calcific thrombi after tissue plasminogen activator treatment

Background and purpose: Embolic stroke has been reported after thrombolysis in cardiac patients but has not yet been documented after thrombolytic therapy for acute ischemic stroke. Description of cases: Patient 1 had a calcific embolus in the right M1 region on head computed tomography (CT) scan when treated with tissue plasminogen activator (tPA). Repeat imaging within hours showed distal migration of calcific fragments into the M2 region. Patient 2 had a calcific embolus in the right M1 region, as well as distal calcific emboli in multiple vascular distributions on initial head CT scan. She was treated with intravenous tPA but became unresponsive within 2 hours. Repeat imaging showed new calcium-density signal in the basilar artery. Conclusions: We present 2 cases of radiographically evident, calcific embolization after tPA therapy for acute ischemic stroke. Emboli with a calcific component may lyse with tPA, but such patients should be carefully monitored for distal or recurrent embolization.