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61.
Introduction Cerebral venous and sinus thrombosis (CVST) is an uncommon cause of stroke that is associated with poor outcomes in high-risk
patients who present with stupor or coma, rapidly progressive neurologic deficits or progressive neurologic deficits during
therapeutic anticoagulation.
Methods and Results We report the rapid treatment of CVST in six patients at high risk for poor outcomes (death or dependency) using rheolytic
thrombectomy combined with locally administered low-dose recombinant tissue plasminogen activator (rt-PA), and review the
literature on rheolytic thrombectomy for CVST. All of the procedures were technically successful. No complications occurred.
Two patients experienced partial rethrombosis following rheolytic thrombectomy requiring a second treatment. Preexisting hemorrhagic
infarcts in two patients remained stable. Two of six patients experienced excellent clinical outcomes. Two had good outcomes.
There were two deaths from irreversible cerebral injury caused by extensive CVST that had occurred prior to the endovascular
treatments. In 24 cases of rheolytic thrombectomy for CVST that were reviewed from this series and previously published reports,
the large majority of patients experienced good to excellent clinical outcomes.
Conclusions Extensive CVST in high-risk patients can be rapidly fatal. Rheolytic thrombectomy combined with locally administered, low-dose
recombinant tissue plasminogen activator (rt-PA) is a safe and effective endovascular method to rapidly recanalize the intracranial
dural sinuses in high-risk patients with CVST.
Disclosure: The authors report no conflicts of interest. 相似文献
62.
63.
rt-PA联合必存静脉溶栓治疗急性期脑梗死42例 总被引:1,自引:0,他引:1
目的:探讨rt-PA联合必存对发病< 6 h的急性期脑梗死患者采用静脉溶栓治疗的临床疗效及并发症.方法:收集我科2008年1月至2010年8月对住院收治发病< 6 h的急性期脑梗死患者42例给予rt-PA(0.9 mg/kg,最大70 mg)静脉溶栓治疗.结果:急性期脑梗死6 h内静脉溶栓率为37.8%,未发生脑出血现象,但神经系统功能完全恢复仍需一段时间.溶栓患者20 d基本治愈61.9%,显著进步26.2%,进步7.1%,无变化2.4%,恶化2.4%.结论:6 h内给予rt-PA(0.9 mg/kg,最大70 mg)静脉溶栓治疗是安全有效的,由于溶栓时间窗狭窄及其适应证和禁忌证的限制,溶栓治疗的比例很小,我们必须提高对脑梗死的认识,一旦出现脑梗死症状,早期诊断,早期溶栓治疗,最大限度提高脑梗死患者的预后. 相似文献
64.
目的 观察及探讨急性脑梗死应用阿替普酶溶栓后联合注射用丹参多酚酸治疗的临床效果。方法 选取新乡市中心医院2018年1月-2018年6月首发急性脑梗死患者71例,其中对照组患者35例,进行阿替普酶静脉溶栓治疗,治疗组患者36例,在对照组基础上应用注射用丹参多酚酸0.13 g/d,共治疗14 d。对比两组治疗效果及两组分别治疗第7天及第14天的美国国立卫生研究院卒中量表(NIHSS)评分和改良RANKIN量表(MRS)评分进行观察比较。结果 治疗组治疗总有效率高于对照组,差异具有统计学意义(P<0.05)。治疗第1天时,NIHSS评分及MRS评分无统计学差异;治疗第7、14天时,两组NIHSS评分均降低,同组治疗前后比较差异有统计学意义(P<0.05);治疗第14天时,观察组NIHSS评分明显低于对照组,差异有统计学意义(P<0.05)。在日常生活能力方面,治疗组与对照组在第7天时,MRS评分无论是组间比较还是组内比较,均无明显差异性;但在第14天时,无论组间比较还是组内比较,MRS评分均有明显的差异性且有显著的统计学意义(P<0.05)。结论 急性脑梗死进行阿替普酶溶栓后联合注射用丹参多酚酸治疗能够有效的改善神经功能缺损症状及显著提高日常生活自理能力,尤其在脑梗死1周之后临床效果更加显著,值得临床推广和应用。 相似文献
65.
Jing Lu Yue-Hua LiYong-Dong Li Ming-Hua LiJun-Gong Zhao Shi-Wen Chen 《European journal of radiology》2012
Purpose
To evaluate treatment decision-making based on susceptibility-weighted imaging (SWI) in patients with hemorrhage after thrombolysis.Materials and methods
One hundred and forty-six patients without intracranial hemorrhage on CT after receiving recombinant tissue plasminogen activator (rt-PA) were allocated to two groups: antiplatelets (n = 72), who received antiplatelet therapy 24 h after rt-PA for 10 days; and non-antiplatelets (n = 74), who received no antiplatelet therapy. Twenty-two patients with SWI-detected microbleeds (MBs) or hemorrhagic transformation (HT) in the antiplatelets group (Group A) and 28 with MB or HT in the non-antiplatelets group (Group B) were included in this study.Results
Sixteen patients had MB and six HT in Group A; 18 had MB, six HT, and four parenchymal hemorrhage (PH) in Group B. National Institutes of Health Stroke Scale (NIHSS) scores at 7 and 14 days and the Modified Rankin Scale (mRS) at 90 days post-rt-PA were significantly lower in Group B than in Group A, duration of hospitalization was significantly shorter, and the favorable outcome rate was higher at 90 days (P < 0.05). There were no other significant differences. SWI evaluation at 14 days revealed eight patients with MB, 11 HT, and three PH in Group A; in Group B, 16 had MB, five HT, and one PH, with resolution of hemorrhage in six patients.Conclusions
Treatment decision-making based on SWI in acute stroke after thrombolysis was validated by the significantly reduced NIHSS score after 7/14 days, improved outcome, and reduced mRS in hemorrhage patients without antiplatelet therapy. 相似文献66.
小剂量rt-PA快速给药30 min与60 min治疗急性心肌梗死疗效观察 总被引:3,自引:1,他引:2
目的旨在为临床在应用rtPA溶栓方面找到一个更好更安全的方案。方法通过比较小剂量50mgrtPA30min与60min快速给药治疗急性ST段抬高性心肌梗死患者的效果89例,随机分为两组:rtPA30min给药和60min给药,比较两组患者临床疗效、冠脉再通率、心脏事件发生率、并发症以及急性期病死率。结果30min给药组再通率高达84.7%,与60min给药组比较患者临床症状改善和冠状动脉再通率均差异有显著性,梗死后心绞痛、再灌流心律失常发生率明显降低,出血并发症没有增加(P<0.05)。结论小剂量rtPA30min治疗AMI是安全可靠有应用价值值得推广的方法。 相似文献
67.
68.
目的观察重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗早期急性脑梗死的疗效和安全性。方法将75例急性脑梗死(发病时间<3 h)患者随机分为2组:溶栓组40例用rt-PA 0.9 mg/kg,先于2 min内静脉注射总量中的10%,再将余量于1 h内静脉泵入;对照组35例不使用rt-PA。2组其他治疗均相同。观察治疗前及治疗后6 h、24 h、7 d3、0 d、90 d的临床神经功能缺损程度评分(CSS),治疗前、治疗后90 d日常生活活动量表(Barthel指数),30 d脑出血率、病死率。结果溶栓组溶栓后6 h、24 h、7 d、30 d、90 d CSS为15.38,13.24,9.30,7.40,5.00分;90 d总显效率为76%;90 d Barthel指数评分为95~100分者占57%;脑出血率为10%;病死率为5%。对照组治疗后6 h2、4 h7、d、30 d、90 d CSS为20.65,18.78,14.90,13.00,11.95分;90 d总显效率为30%;90 d Barthel指数评分为95~100分者占22%;无颅内出血;病死率为9%。溶栓组CSS明显低于对照组(P<0.01),总显效率明显高于对照组(P<0.01)。结论急性脑梗死早期应用rt-PA静脉溶栓是安全有效的。 相似文献
69.
Introduction The aim of our study was to evaluate the safety and efficacy of intra-arterial (IA) thrombolysis using recombinant tissue
plasminogen activator (rt-PA) in patients with acute stroke due to occlusion in the anterior or posterior circulation.
Methods We retrospectively analyzed the clinical and radiological data of 88 consecutive patients with acute ischemic stroke who underwent
emergency cerebral angiography for the purpose of subsequent IA thrombolysis. The neurological deficit on admission and discharge
was graded using the National Institutes of Health Stroke Scale (NIHSS) score. Baseline computer tomography (CT) scans were
examined for any signs indicative of cerebral ischemia. The angiographic findings were classified according to the Thrombolysis
in Myocardial Infarction (TIMI) score for myocardial infarction. Follow-up CT scans were examined for hemorrhagic complication.
Results Of the 88 patients who underwent IA thrombolysis, 63 presented with complete or partial arterial occlusion in the suspected
perfusion area. In these 63 patients, the median NIHSS score dropped from 15 points on admission to 10 points at discharge.
The recanalization rate was 52.6% for partial and complete reperfusion. In-hospital mortality was 20.6% (9.1% for carotid,
44.4% for basilar territory occlusion). Intracerebral bleeding (ICB) occurred in 38.6% of the patients with occlusion in the
anterior circulation, resulting in these patients presenting a worse clinical outcome than those without ICB. Only minor extracranial
bleedings occurred in 20.6% of patients. Patients with ICB had a significantly higher frequency of ischemic signs on the baseline
CT scan.
Conclusion Occlusion of a cerebral artery is present in about 75% of the patients eligible for thrombolytic therapy. Intra-arterial thrombolysis
using rt-PA in patients with acute ischemic stroke can achieve re-vascularization, although ICB remains the major risk factor
affecting its efficacy. 相似文献
70.
rT—RA溶栓治疗急性颈内动脉系统脑梗死 总被引:1,自引:0,他引:1
目的:探讨rt-PA治疗发病6h内颈内动脉系统脑梗死的得失。方法:rt-PA0.8mg·kg-1,低分子肝素、右旋糖酐40和复方丹参联合应用。结果:3个月后痊愈或基本痊愈7例,预后较好6例,较差2例,死亡6例。死亡病例的初始中风量表(SSS)低,脑肿胀严重。死于严重的缺血性脑水肿2例,出血性梗死1例,巨大脑内血肿1例。结论:初始SSS越低,预后越差;严重缺血性脑肿胀是导致死亡的值得注意的因素。 相似文献