Thrombolysis Following Central Venous Catheter Placement

•Presently available thrombolytic agents are administered by infusion.•We report a case of an acute ischemic stroke patient for whom we were unable to secure a peripheral venous route.•Thrombolysis following central venous catheter placement was observed to be safe and effective in this patient.•From a time-sparing perspective, prolonged efforts to obtain peripheral vein access should be avoided.•To reduce the risk of penetration of the posterior vessel wall or accidental arterial puncture, ultrasound guidance is strongly recommended. Thrombolytic agents are infusion formulations, and some patients cannot be cannulated by a peripheral venous route. This report describes a patient with acute ischemic stroke who was administered alteplase following central venous catheter placement. An 82-year-old man with paroxysmal atrial fibrillation presented with left unilateral spatial neglect and left hemiparesis. Magnetic resonance imaging showed acute cerebral infarction located in the right cerebrum without occlusion of the main artery. The infarction was considered appropriately indicated for thrombolysis. However, no peripheral venous access could be secured, even by trained emergency room physicians. A central venous catheter was therefore placed in the right jugular vein and thrombolysis was performed. After treatment, neurological deficits completely resolved without any clinically serious bleeding. Venous catheter placement may be a safe alternative to peripheral vein access in such a circumstance.