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1.
《Revue neurologique》2019,175(9):519-527
Background and purposeHospitals admitting acute strokes should offer access to mechanical thrombectomy (MT), but local organisations are still based on facilities available before MT was proven effective. MT rates and outcomes at population levels are needed to adapt organisations. We evaluated rates of MT and outcomes in inhabitants from the North-of-France (NoF) area.MethodWe prospectively evaluated rates of MT and outcomes of patients at 3 months, good outcomes being defined as a modified Rankin scale (mRS) 0 to 2 or like the pre-stroke mRS.ResultsDuring the study period (2016–2017), 666 patients underwent MT (454, 68.1% associated with intravenous thrombolysis [IVT]). Besides, 1595 other patients received IVT alone. The rate of MT was 81 (95% confidence interval [CI] 72–90) per million inhabitants-year, ranging from 36 to 108 between districts. The rate of IVT was 249 (95% CI 234–264) per million inhabitants-year, ranging from 155 to 268. After 3 months, 279 (41.9%) patients who underwent MT had good outcomes, and 167 (25.1%) had died. Patients living outside the district of Lille where the only MT centre is, were less likely to have good outcomes at 3 months, after adjustment on age, sex, baseline severity, and delay.ConclusionThe rate of MT is one of the highest reported up to now, even in low-rate districts, but outcomes were significantly worse in patients living outside the district of Lille, and this is not only explained by the delay. 相似文献
2.
目的探讨介入疗法在急性肢体动脉闭塞治疗中的应用价值。方法回顾性总结28例急性肢体动脉闭塞介入治疗经验。采用经皮血管腔内成形术和动脉内溶栓术治疗上肢动脉闭塞5例、腹主动脉下段闭塞1例、下肢动脉闭塞22例。结果经术后4个月~9年临床观察,急性单段动脉闭塞血管再通率为100%(8/8例)、多段动脉闭塞血管再通率为80%(16/20例),总血管再通率为85.71%(24/28例)。结论介入疗法是治疗急性肢体动脉闭塞的一种有效方法,值得推广应用。 相似文献
3.
Klaus Rauber Kathrin S. Heidinger Bettina Kemkes-Matthes 《Cardiovascular and interventional radiology》1997,20(3):169-173
Purpose To determine the systemic effects of local fibrinolytic therapy with low-dose recombinant tissue-type plasminogen activator
(rt-PA).
Methods Ten patients received intrathrombal infusion of 20 mg rt-PA and heparin for local thrombolysis and had subsequent percutaneous
transluminal angioplasty (PTA). Eight controls underwent PTA and received heparin alone. We measured t-PA, D-Dimer, and fibrinogen
levels before, directly after, and 20, 40, and 60 min and 24 hr after therapy.
Results In the thrombolysis group the t-PA level peaked immediately after infusion and then declined within 1 hr. D-Dimer increased
and remained elevated, whereas in the control group only t-PA levels increased, and only after 24 hr. Fibrinogen remained
within the normal range in both groups. Eight of ten patients in the thrombolysis group and seven of eight with PTA had clinical
improvement after the procedure.
Conclusions The increase in D-Dimer in the rt-PA group indicates a good local fibrinolytic effect. The fact that fibrinogen levels remained
unchanged indicates that there is a lack of systemic fibrinogenolysis. 相似文献
4.
超早期选择性动脉内溶栓术治疗急性脑梗死的疗效分析 总被引:1,自引:0,他引:1
目的探讨超早期选择性动脉内溶栓治疗急性脑梗死的方法和疗效。方法经股动脉插管将微导管送入阻塞部位,给尿激酶75万U,0.9%氯化钠50ml,用微量泵以100ml/h的速度推注,注药前后造影观察血管再通情况。结果11例血管通率,67%,4周疗效基本痊愈:82%,显著进步:18%,显效率:100%。结论超早期溶栓能恢复血流灌注,可阻断脑梗死的病理过程,避免脑细胞的坏死,能明显提高治愈率,降低致残率。 相似文献
5.
G. F. Hamann 《Der Radiologe》1997,37(11):843-852
Summary
This review focuses on the pathophysiological changes in acute cerebral ischemia, with special emphasis on disturbances of
the cerebral blood flow (CBF) and the associated penumbra concept. Alternatively, the model of peri-infarct depolarization
is demonstrated. Metabolic and molecular changes caused by cerebral ischemia and reperfusion are discussed, namely energy
failure, release of glutamate with an excitatoric burst, calcium influx in neurons, generation of free radicals, activation
of different proteases, disturbances of protein synthesis, induction of gene expression and apoptosis, loss of membrane integrity,
edema formation and microvascular disturbances. In summary, the pathophysiological changes after focal cerebral ischemia and
reperfusion are most adequately described by a network of interacting different mechanisms of tissue alterations. The simple
concept of a cascade of ischemic effects which would be easy to block seems to be less applicable. A time window of approximately
6 h for the acute stroke therapy is postulated on the base of the above mentioned pathophysiological changes. The recently
introduced treatment regimen with optimized basic treatment, recanalization using thrombolysis and neuroprotection by different
agents is presented. Different modes of a possible intervention are discussed. Modern concepts of stroke therapy including
stroke-unit care and thrombolysis with add-on neuroprotection seem to have potential for improving the outcome of acute stroke
patients.
相似文献
6.
Timothy J. Hodgson Peter A. Gaines Jonathon D. Beard 《Cardiovascular and interventional radiology》1994,17(6):333-335
Acute lower limb ischemia secondary to Buerger's disease in a young patient responded to thrombolysis and subsequent popliteal and anterior artery angioplasty. The value of angioplasty in non-limb-threatening ischemia in Buerger's disease has not been established but this case illustrates a role for thrombolysis and angioplasty in acute ischemia. 相似文献
7.
溶栓及经皮冠脉腔内成形术治疗急性心肌梗死的疗效分析 总被引:1,自引:0,他引:1
目的 对比直接冠状动脉腔内成形术 (PTCA)及静脉尿激酶 (UK)溶栓对急性心肌梗死 (AMI)治疗的临床疗效。方法 采用观察性队列研究的方法 ,对 97例AMI患者采用UK溶栓 ,60例AMI患者采用直接PTCA治疗 ,比较两组住院期及随访期的超声心动图 (UCG)和临床结果。结果 住院期间UCG检查室壁运动正常者在PTCA组为 (4 6.0 0 % ) ,高于UK组 (2 4.73 % ) (p =0 .0 2 1) ,矛盾运动发生率PTCA组为 0 ,而UK组为 11.83 %。LVEF在PTCA组为 5 6.88± 10 .47,高于UK组 (5 1.5 8± 10 .97) (p =0 .0 41)。住院期心衰发生率UK组为 3 2 .5 9% ,高于PTCA组 (18.3 3 % ) (p =0 .0 2 9)。随访 13 .3 2± 6.86个月累计心衰发生率UK组为 16.2 8% ,也高于PTCA组 (5 .19% ) (p =0 .0 0 1)。住院期间的病死率UK组为 10 .3 1% ,PTCA组为 5 .0 0 % (p =0 .10 0 )。累计病死率UK组为 15 .5 6% ,明显高于PTCA组 (5 .0 0 % ) (p =0 .0 2 1)。 60岁以上年龄组累计的病死率仍然是UK组 (2 8.99% )高于PTCA组 (10 .3 4% ) (p =0 .0 49)。在随访 3、6、12及 2 4个月时PTCA组的生活质量计分各自为 :5 9.90± 14 .67、74.40± 12 .86、73 .86± 9.70、82 .47± 10 .47均高于同时期UK组的计分 (分别是 5 2 .0 8± 14 .49、65 .0 0± 14 .72、67.0 2 相似文献
8.
C. A. Reynard P. Calain G. P. Pizzolato Dr. J. C. Chevrolet 《Intensive care medicine》1992,18(4):247-249
We report the first case of lethal intracranial haemorrhage complicating a treatment by rt-PA in a patient presenting with a simultaneous staphylococcal septicemia with meningoencephalitis and an acute myocardial infarction with cardiogenic shock. The presence of microvascular lesions in the central nervous system seems to be important risk factor for intracranial haemorrhage and we recommend extreme caution in the use of thrombolytic treatment in septicemic patients with acute myocardial infarction, particularly when neurological symptoms are present. 相似文献
9.
急性心肌梗塞错误溶栓治疗12例分析 总被引:1,自引:0,他引:1
自1993年12月至1995年8月,对155例急性心肌梗塞(AMI)病人进行溶栓治疗,12例发生误溶(7.7%)。其中早期复极综合征4例,室壁瘤2例,心肌炎1例,心肌病1例,完全性左束支阻滞1例,间歇性左前分支阻滞互例,其它2例。本文分析了误溶病例与AMI的鉴别要点,并提出了减少误溶,提高诊疗水平的措施。 相似文献
10.
Chouvarda I Maglaveras N Boufidou A Mohlas S Louridas G 《Medical & biological engineering & computing》2003,41(6):609-617
Non-stationary analysis of electrocardiograms (ECGs) using Wigner-Ville distribution is presented. Analysis was performed
on subjects with acute myocardial infarction who had undergone thrombolysis, in Holter recordings of lead V1. The distinction
between successfully and non-successfully thrombolysed patients was evaluated, based on time-frequency features of the Wigner-Ville
transformed ECGs at the sixth hour after lysis. Characteristic parameters were extracted from time-frequency areas, and linear
discriminant analysis was performed on these parameters, leading to a prediction index to distinguish the two classes. Thirteen
features were found statistically significant by t-test and were used for the classification with linear modelling. Out of
these features, four corresponded to frequencies lower than 25 Hz and higher than 50 Hz for, roughly, the QRS complex, five
features corresponded to all the frequency bands of, roughly, the ST area, and the last four features corresponded to the
T-wave. The feature-vector used in linear modelling was iteratively generated, and the iterative prediction found all 18 features
significant. The iterative method resulted in better classification than that of the standard statistical procedure (3.8%
error against 18.1% with the classic method). The evolution of the prediction index with time for the first 12 h was different
for the successfully and non-successfully thrombolysed groups. Specifically, in the successful thrombolysis group, oscillations
and variation with time were more obvious, indicating a possible difference in the dynamics of the cardiac system. 相似文献