Thrombolysis beyond the time window in takayasu's arteritis: A challenging experience

Takayasu's arteritis (TA) is chronic inflammatory vasculopathy preferentially affecting the aorta and its major branches. It is one of the potential causes of stroke in young adults. Here, we report a young female who presented to us with an acute-onset right hemiparesis with motor aphasia after 10 h of symptoms onset. Her National Institute of Health Stroke Scale (NIHSS) score at admission was 12. The stroke imaging showed acute infarct in the left middle cerebral artery territory with arterial spin labelling perfusion sequence showing diffusion perfusion mismatch with good penumbra. She underwent intravenous thrombolysis with tenecteplase, based on imaging findings and despite being out of window period. She had an excellent clinical recovery and was discharged with oral anticoagulant and azathioprine. After 3 months of stroke and recovery, follow-up was unremarkable with minimal residual deficits with an NIHSS score of 4 and Modified Rankin Scale of 1. Hence, appropriate early interventions in acute stroke in TA individuals are highly beneficial and timely considered for a good outcome and better quality of life.