Successful intravenous alteplase for acute ischemic stroke secondary to radiation-induced intracranial arterial stenosis in a child: An illustrative case

Background: Delayed cerebrovascular complications after radiotherapy have been well-documented. However, optimal management of acute ischemic stroke secondary to radiation-induced intracranial arterial stenosis remains unclear. Case Description: A 17-year-old girl developed an acute ischemic stroke secondary to delayed middle cerebral artery stenosis following radiotherapy for recurrent craniopharyngioma after tumor resection. Intravenous alteplase (rt-PA) was administered 4 h after symptom onset, resulting in neurological improvement, and she was discharged with a modified Rankin Scale score of 0. Conclusion: This case suggests that rt-PA may be an effective treatment option for acute ischemic stroke associated with post-radiotherapy arterial stenosis, provided that the standard eligibility criteria are met.