Orolingual and abdominal angioedema post thrombolysis and thrombectomy.

A 53-year-old man treated with an angiotensin-converting enzyme (ACE) inhibitor presented with left hemiplegia (NIH Stroke Scale 23). Magnetic resonance angiography revealed a right proximal middle cerebral artery occlusion (figure 1). Thirty minutes after thrombolysis, orolingual swelling was observed. Two hours later, just after mechanical thrombectomy was completed, he developed painful abdominal edema, which improved after icatibant administration (figure 2). Bradykinin-mediated angioedema can be a complication of recombinant tissue plasminogen activator, typically orolingual, with increased risk for patients on ACE inhibitors. We speculate that the procedure of thrombectomy, acting as a mechanical stress, could have been a triggering factor for the unusual presentation of abdominal edema.