Background and purpose The clinical benefits of intra-arterial thrombolysis for ischemic stroke must be weighed against the risks, including hemorrhagic conversion.

Summary of case A case of angiographically documented hemorrhagic conversion of an ischemic stroke during intra-arterial thrombolysis is presented. Discussion focuses on recognition and management of risk factors for hemorrhagic conversion during performance of stroke thrombolysis.

Conclusions Recognition and modification of risk factors for hemorrhagic conversion may not prevent this complication during stroke thrombolysis. Identification of the angiographic appearance of hemorrhagic conversion should alert the interventionalist to the likelihood of a poor clinical outcome regardless of vessel patency status.