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Dramatic recovery after intravenous t-PA therapy may be associated with early recanalization of the occluded vessel. On the contrary, no clinical improvement may indicate persistent occlusion, and clinical aggravation may result from untimely re-perfusion, causing irreversible brain damage because of severe ischemia. Diffusion-weighted magnetic resonance imaging (DWI) was useful to determine the early ischemic change by main artery occlusion, and the DWI/PWI mismatch was helpful to decide the indication of intravenous t-PA therapy. Digital subtraction angiography was performed to evaluate recanalization of the occluded artery after intravenous t-PA therapy. Percutaneous transluminal angioplasty was useful if the arterial occlusion had persisted. Ten cases of this protocol show good outcome and no hemorrhagic complications. It is important to ensure early re-perfusion of the undamaged brain (penumbra).
