Intravenous Thrombolysis in Two Patients with Acute Ischemic Stroke Treated with Chronic Hemodialysis

Patients with renal failure have a higher risk for cerebrovascular events and silent brain damage and a higher cardiovascular mortality rate when compared with the general population. We present two cases where alteplase was used for hemodialysis patients (HP) with acute ischemic stroke (AIS). A 70-year-old Caucasian female with a 2-year history of hemodialysis was admitted with right hemiparesis and aphasia (National Institutes of Health Stroke Scale, NIHSS: 15 pts.), which occurred during a hemodialysis session (HS). On the third day of hospitalization, after initial neurological improvement (NIHSS after 24 hours: 9 pts.), the patient died because of massive intestinal bleeding. A 54-year-old Caucasian female with a 4-year history of hemodialysis was admitted after two incidents of ipsilateral transient ischemic attacks (TIA), which occurred between HSs. 30 min after admission, right hemiparesis and aphasia occurred (NIHSS: 16 pts. ). 3 months after stroke onset, the patient was functionally independent (NIHSS:2).