We studied the clinical characteristics of 10 patients with acute ischemic stroke (AIS) with  unruptured intracranial aneurysm (UIAs) treated with intravenous thrombolysis (IT).

Since the number of described cases with UIAs treated with IT is low, and  most of them are of Asian origin, we decided to present  10 Caucasians with UIAs treated by IT due to AIS.   

We analyzed data from the Krakow Stroke  Data Bank  - a single center, hospital-based stroke registry.  The standardized diagnostic work-up included: demographics; stroke risk factors; stroke etiology, stroke severity and treatment. Outcome measures were:  hemorrhagic complications,  mRS on discharge,  90 days after stroke and up to April 2019. All participants had performed the radiological work-up, including computed tomography (CT) with and without contrast, perfusion CT, angio- CT of intra and extracranial vessels, and arch of aorta. 24 hours later all patients had non contrast CT. 

We analyzed data from 362 patients treated with IT from  2014 to 2018. Patients with UIAs were older as compared to others, and were more often females. NIHSS on admission of cases with UIA was 12,5±4,8; UIA was located on the vessel affected by AIS in 2 cases; 1 patient presented brain hemorrhage. mRS on day 90 was as follows: 0 (n=3); 1 (n=2); 2  (n=2); 3 (n=1); 6 (n=2).  Eight cases were alive up to April 2019.  In 9 cases  the aneurysm size varied from 2-6 mm, In one case the size was 12 mm. Literature shows only 8 cases with the UIA sized >10 mm treated with IT.

Introducing expanded radiological diagnostic protocol before treatment decision of  AIS in the era of different etiological treatment options,  allows not only to detect the size of penumbra, clot location but also  the presence of malformations, including IUAs. This improves confidence of the  decision about individual AIS treatment strategy.