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Richard Blythe Azza Ismail Aaizza Naqvi 《Journal of stroke and cerebrovascular diseases》2019,28(6):e75-e76
Intravenous recombinant tissue-plasminogen-activator (rtPA) and mechanical-thrombectomy (MT) are currently the only approved treatments for acute ischemic stroke. Their effectiveness was demonstrated in several clinical trials, and is therefore standard of care. Pregnant women were not included in these studies and consequently the effectiveness and safety in this group are unclear. We present a rare case of a patient in the third-trimester of pregnancy that underwent MT. A 29-year-old woman of 39 weeks’ gestation presented with left facial-paresis, hemiparesis, and neglect. Her CT-Angiogram showed a large occlusive thrombus within the right M1-M2 segments. During pregnancy she had developed thrombocytopenia. There was initial treatment decision dilemma. In view of her history of thrombocytopenia, there was concern about administering rtPA due to the risk of bleeding. As the thrombus was large, rtPA may also be ineffective. MT was proposed by the Stroke Physician as the preferred treatment option. A concern from the Interventional-Radiologist was the risk of exposure to radiation and contrast agents. As the patient had a disabling stroke at a young age, decision was made to proceed with MT which started 141 minutes after symptom onset. The clot was aspirated without complications. Final check angiogram showed complete resolution of flow within the right middle cerebral artery territory. The patient underwent elective uncomplicated Caesarean-section 5 days later delivering a healthy new born. Severe stroke in pregnancy is rare, but has grave consequences for both mother and infant. Timely decision-making is crucial. Our case demonstrates that MT can be provided safely and effectively in the third trimester of pregnancy. 相似文献
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目的 大多数急性缺血性卒中患者难以在发病早期接受静脉溶栓治疗,而移动卒中单元(mobile
stroke unit,MSU)的应用将静脉溶栓治疗从院内提到院前。本研究初步探讨中国首台MSU在急性卒中
患者院前静脉溶栓中的作用。
方法 回顾性分析荥阳市人民医院卒中中心2018年11月-2019年4月期间应用MSU进行院前静脉溶
栓的患者(MSU溶栓组)和使用传统救护车转运至院内静脉溶栓的患者(常规溶栓组)的临床资料。
观察终点包括主要时间指标从呼叫至溶栓时间、从发病至溶栓时间;疗效指标为90 d良好预后(mRS
评分≤2分)率;安全性指标包括溶栓后48 h内症状性颅内出血及随访90 d内的全因死亡。比较静脉
溶栓患者应用两种治疗模式的终点差异。
结果 MSU溶栓组共计14例患者接受了院外静脉溶栓,同时期常规溶栓组有24例患者在院内进行了
静脉溶栓治疗。与常规溶栓组相比,MSU溶栓组呼叫至溶栓时间(59 min vs 92 mi n,P =0.001)、发病
至溶栓时间(73 min vs 114 mi n,P =0.002)均较短。两组的90 d良好预后率(79% vs 67%,P =0.488)
和安全性指标均未见统计学差异。
结论 基于MSU的急性缺血性卒中院前溶栓可以显著缩短患者从发病至溶栓时间及呼叫至溶栓时
间,但对于急性卒中的救治疗效仍需要多中心前瞻性研究进一步验证。 相似文献
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目的评价超选择性动脉溶栓治疗急性缺血性脑卒中的疗效和安全性。方法选择2003年1月至2005年5月于本院进行超选择性动脉溶栓同时采用卒中登记方法收集的58例急性缺血性脑卒中患者,随访6个月,观察患者的预后。结果58例患者中并发脑出血6例(10.3%),其中症状性脑出血2例(3.4%)。1个月末、3个月末和6个月末分别死亡2例(3.4%)、4例(6.8%)和5例(9.3%)。3个月末和6个月未残疾或死亡例数分别为13例(22.4%)和9例(16.7%)。结论对选择的急性缺血性脑卒中患者进行超选择性动脉溶栓是有效和安全的。 相似文献
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Benjamin P. George Thomas A. Pieters Christopher G. Zammit Adam G. Kelly Kevin N. Sheth Tarun Bhalla 《Journal of stroke and cerebrovascular diseases》2019,28(4):980-987
Objective: Stroke care in the US is increasingly regionalized. Many patients undergo interhospital transfer to access specialized, time-sensitive interventions such as mechanical thrombectomy. Methods: Using a stratified survey design of the US Nationwide Inpatient Sample (2009-2014) we examined trends in interhospital transfers for ischemic stroke resulting in mechanical thrombectomy. International Classification of Disease—Ninth Revision (ICD-9) codes were used to identify stroke admissions and inpatient procedures within endovascular-capable hospitals. Regression analysis was used to identify factors associated with patient outcomes. Results: From 2009-2014, 772,437 ischemic stroke admissions were identified. Stroke admissions that arrived via interhospital transfer increased from 12.5% to 16.8%, 2009-2014 (P-trend < .001). Transfers receiving thrombectomy increased from 4.0% to 5.2%, 2009-2014 (P-trend?=?.016), while those receiving tissue plasminogen activator increased from 16.0% to 20.0%, 2009-2014 (P-trend < .001). One in 4 patients receiving thrombectomy were transferred from another acute care facility (n?=?6,014 of 24,861). Compared to patients arriving via the hospital “front door” receiving mechanical thrombectomy, those arriving via transfer were more often from rural areas and received by teaching hospitals with greater frequency of thrombectomy. Those arriving via interhospital transfer undergoing thrombectomy had greater odds of symptomatic intracranial hemorrhage (adjusted odds ratio [AOR] 1.19, 95% CI: 1.01-1.42) versus “front door” arrivals. There were no differences in inpatient mortality (AOR 1.11, 95% CI: .93-1.33). Conclusions: From 2009 to 2014, interhospital stroke transfers to endovascular-capable hospitals increased by one-third. For every ~15 additional transfers over the time period one additional patient received thrombectomy. Optimization of transfers presents an opportunity to increase access to thrombectomy. 相似文献
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Yu Fan Xiaoling Liao Yuesong Pan Kehui Dong Yilong Wang Yongjun Wang 《Journal of stroke and cerebrovascular diseases》2019,28(1):220-226
Background
The intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) therapy is safe and efficient during the treatment of acute ischemic stroke. Nonetheless, the different outcomes among various stroke subgroups have limited data with regard to the safety and efficacy of cryptogenic stroke (CS). The present study compared the safety and efficacy when IVT with rt-PA was used for the treatment of CS and the other stroke subtypes.Methods
This study classified the IVT with rt-PA patients within 4.5 hours after stroke onset, based on the trial of ORG 10172 in acute stroke treatment criteria in terms of diagnostic evaluation. The data were obtained from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China database, a large multicenter prospective registry. A multivariable logistic regression model was employed to compare the differences between the subtypes in symptomatic intracerebral hemorrhage (sICH) within 7 days and studied the mortality and the outcome during 90 days.Results
In total, 1118 patients were recruited; of these, 131 (11.7%) suffered from CS and 987 (88.3%) with the other etiology. In the CS group, patients were younger than those in the other etiology groups (P < .001). Moreover, it had a lower prevalence of previous stroke (P?=?.0117), receiving antiplatelet drug in 24 hours prior to thrombolysis (P?=?.0017), and functional independence (mRS > 1 before stroke, P?=?.003). The CS group had lower blood pressure (systolic blood pressure P?=?.0001; diastolic blood pressure; P?=?.0212) before thrombolysis, atrial fibrillation (P < .001), and diabetes mellitus (P?=?.0005). Transient ischemic attack, hypertension, hyperlipidemia, blood glucose, receiving anticoagulants in 24 hours prior to thrombolysis, and standard dosage of rt-PA were equally distributed in both groups. After the adjustment of confounders between the CS and the other subgroups, no obvious differences were observed in sICH rate and mortality (P > .05) The CS patients exhibited excellent recovery (mRS, 0-1; 63.78%) and functional independence (mRS, 0-2; 74.8%) than the large artery atherosclerosis patients.Conclusions
IVT with rt-PA is a safe and effective method for the treatment of CS patients. 相似文献8.
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急性缺血性卒中静脉溶栓的患者临床预后可受疾病严重程度、发病到溶栓的时间、脑小
血管病、血糖水平、中性粒细胞计数、血小板计数、溶栓后再灌注损伤及出血转化等多种因素的影响。
本文从流行病学、溶栓前后影响缺血性卒中静脉溶栓预后的危险因素及相关预测模型进行文献复习,
旨在加强对缺血性卒中患者静脉溶栓后不良预后危险因素及相关预测模型的认识,为其防治提供理
论依据和临床指导。 相似文献
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急性缺血性卒中静脉溶栓的患者临床预后可受疾病严重程度、发病到溶栓的时间、脑小
血管病、血糖水平、中性粒细胞计数、血小板计数、溶栓后再灌注损伤及出血转化等多种因素的影响。
本文从流行病学、溶栓前后影响缺血性卒中静脉溶栓预后的危险因素及相关预测模型进行文献复习,
旨在加强对缺血性卒中患者静脉溶栓后不良预后危险因素及相关预测模型的认识,为其防治提供理
论依据和临床指导。 相似文献
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Early Blood‐Brain Barrier Disruption after Mechanical Thrombectomy in Acute Ischemic Stroke 下载免费PDF全文
Zhong‐Song Shi Gary R. Duckwiler Reza Jahan Satoshi Tateshima Viktor Szeder Jeffrey L. Saver Doojin Kim Latisha K. Sharma Paul M. Vespa Noriko Salamon J. Pablo Villablanca Fernando Viñuela Lei Feng Yince Loh David S. Liebeskind 《Journal of neuroimaging》2018,28(3):283-288
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目的探索医疗保险状态对急性缺血性脑卒中(AIS)患者选择静脉内溶栓治疗的影响。方法回顾性收集2012年5月至2016年1月收治的符合静脉内溶栓治疗指征的AIS患者293例,根据患者的医疗保险状态分为医保组256例和非医保组37例,比较两组的临床基线资料,并采用Logistic回归分析医疗保险状态与选择静脉内溶栓治疗的相关因素。结果医保组静脉内溶栓177/256例(69.1%);非医保组静脉内溶栓30/37例(81.1%),两组间比较差异无显著性(P=0.136)。医保组患者年龄更大(P0.001),合并有高血压病史(P=0.040)、冠心病史(P=0.008)和既往脑卒中史的比例更高(P=0.002),住院天数明显延长(P0.001),住院总费用增高(P=0.077)。多因素Logistic回归分析提示:高龄(P0.001)、血脂异常(P=0.005)、入院时美国国立卫生研究院卒中量表(NIHSS)评分高(P0.001)、发病至来院时间长(P=0.006)是AIS患者选择接受静脉内溶栓治疗的独立预测因素。在接受静脉内溶栓治疗的患者中,医保组与非医保组的溶栓开始时间差异无显著性(P=0.612)。结论年龄轻、高NIHSS评分、发病时间短且伴有血脂异常的AIS患者更倾向于接受静脉内溶栓治疗,是否有医疗保险不影响患者对静脉内溶栓治疗的选择;无论是否有医疗保险,患者接受静脉内溶栓治疗的开始时间相似;有医疗保险患者住院时间更长,住院总费用更高。 相似文献
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目的 探索发病前口服抗栓药物对急性缺血性卒中患者静脉溶栓安全性的影响。
方法 研究对象为2018年1-12月的全国、多中心、缺血性卒中住院患者登记研究中进行了rt-PA静脉
溶栓的患者。根据患者发病前是否应用抗栓药物,将患者分为观察组(发病前口服抗栓药物)和对照
组(发病前未口服抗栓药物)。比较两组的基线信息、溶栓后症状性颅内出血率和在院全因死亡率的
差异,并采用多因素回归分析发病前应用抗栓药物对患者溶栓后住院期间安全性的影响。
结果 本研究共纳入了全国1374家医院的17 587例rt-PA静脉溶栓的急性缺血性卒中住院患者。其
中,有3313例(18.8%)发病前应用抗栓药物,纳入观察组,14 274例(81.2%)发病前未应用口服抗
栓药物,纳入对照组。与对照组相比,观察组患者年龄较高(67.7±11.1岁 vs 64.8±12.2岁),男
性比例较低(63.6% vs 65.7%),既往血管危险因素比例较高,入院NIHSS>15分的患者比例较高
(16.1% vs 13.5%),差异均有统计学意义。观察组溶栓后症状性颅内出血的发生率(0.12% vs 0.07%,
P =0.156)和在院全因死亡率(1.72% vs 1.16%,P =0.010)均高于对照组,但多因素校正后,两组溶
栓后症状性颅内出血(HR 1.133,95%CI 0.220~5.822,P =0.881)和在院全因死亡(HR 0.912,95%CI
0.612~1.359,P =0.651)方面的差异均未达统计学意义。
结论 发病前应用抗栓药物对急性缺血性卒中患者静脉溶栓的短期安全性无显著影响,不增加
症状性颅内出血的发生率和在院全因死亡率。 相似文献
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