Rheolytic Thrombectomy for Cerebral Sinus Thrombosis

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.     

院前静脉溶栓治疗急性心肌梗死的临床随机对照研究

目的　评价重组组织型纤溶酶原激活剂 (rt PA)在院前救治急性心肌梗死 (AMI)的近期临床治疗效果 ,并探讨在院前对AMI患者进行静脉溶栓治疗的安全性和可行性。方法　对所收治的AMI患者进行分组 ,均给予rt PA( 5 0mg)进行静脉溶栓治疗 ,对比两者的冠状动脉再通率以及发病至溶栓时间延迟对rt PA静脉溶栓疗效的影响。结果　从患者发病至进行溶栓治疗的时间间隔 ,院前组平均比院内组缩短 2 .2小时 [( 2 .9± 1.4)小时比 ( 5 .1± 1.1)小时 ] ,P <0 .0 5 ;院前治疗组的冠状动脉总再通率为 90 % ,明显高于院内治疗组的 61.8% (P <0 .0 5 )。结论　院前应用rt PA( 5 0mg)进行静脉溶栓治疗安全、可行。     

注射用丹参多酚酸联合阿替普酶治疗急性脑梗死后的疗效分析

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。     

神经介入联合rt-PA静脉溶栓治疗缺血性脑卒中的临床研究

目的 探讨神经介入联合rt-PA静脉溶栓治疗缺血性脑卒中的临床疗效.方法 306例缺血性脑卒中患者随机分为两组各153例,对照组采用rt-PA静脉溶栓治疗,实验组采用神经介入联合rt-PA静脉溶栓治疗,比较两组的治疗效果.结果 实验组的治疗总有效率高于对照组(P＜0.05).治疗后,实验组的hs-CRP、S100β、N...     

银杏内酯注射液联合阿替普酶静脉溶栓治疗急性缺血性脑卒中的临床对照研究

目的 探讨银杏内酯注射液联合阿替普酶静脉溶栓治疗急性缺血性脑卒中的安全性及临床疗效。方法 选取87例急性缺血性脑卒中患者,分为对照组及试验组。对照组39例,给予阿替普酶静脉溶栓治疗,10%注射用阿替普酶（0.9 mg/kg）iv,其余90%在1 h内静脉滴注完毕,后给予生理盐水iv,24 h后给予缺血性卒中的基础用药;试验组48例,在相同方法静脉溶栓后立刻给予银杏内酯注射液,6 mL加入250 mL生理盐水中,静脉滴注,1次/d,连续用药14 d,溶栓24 h后给予缺血性卒中的基础用药。所有入选患者分别于治疗前、治疗后14、90d记录美国国立卫生研究院卒中量表（NIHSS）评分,并记录不良反应事件,治疗后14、90 d进行改良Rankin量表（mRS）评分1次、检测BI指数1次。按照TOAST分型将两组患者进行分类,并对大动脉粥样硬化型及小动脉闭塞型患者进行分析。结果 两组患者用药后均未出现颅内出血;用药后90 d,试验组的NIHSS评分、mRS评分较对照组显著降低,BI指数显著升高;试验组的大动脉粥样硬化型患者用药后90 d的NIHSS评分、mRS评分较对照组明显降低,BI指数显著升高;而小动脉粥样硬化型患者与对照组比较差异不显著。结论 银杏内酯注射液联合阿替普酶静脉溶栓治疗急性缺血性脑卒中患者安全性高,且明显改善患者预后。     

rt-PA静脉溶栓联合高压氧治疗急性脑梗死的效果观察

目的评价重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓联合高压氧(HBO)治疗急性缺血性脑梗死的安全性和有效性。方法选取上海市浦东医院急性脑梗死患者78例,随机分为A组rt-PA溶栓治疗组38例和B组rt-PA联合HBO 40例。两组患者均在发病4.5h内采用rt-PA静脉溶栓治疗,B组患者在接受上述治疗后立即进高压氧舱进行治疗。两组患者疗程均为20d,分别在治疗24h、10d及20d采用NIHSS及ADL评分进行神经功能及日常生活能力评估,并通过患者发生再次脑梗、TIA发作、脑出血及死亡率进行治疗方案有效性及安全性评估。结果治疗前后2组NIHSS评分与ADL评分比较,治疗后24h、10d、20d2组评分与治疗前比较有显著性差异(P0.05),且呈时间依赖性;两个治疗组相比较,NIHSS评分在24h及20d时差异具有统计学意义(P0.05),ADL评分在20d时差异具有统计学意义(P0.05);A、B两组相比较,患者发生再次脑梗、TIA发作、脑出血及死亡率差异无统计学意义(P0.05)。结论 rt-PA联合HBO治疗急性期脑梗死与单用rt-PA的疗效相比,在超早期及长期治疗的效果较好,因此该治疗方法是安全有效的。     

rt-PA静脉溶栓治疗急性脑梗死的研究

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。     

用HAT评分预测rt-PA静脉溶栓治疗脑梗死后出血的临床研究

[目的]探索HAT评分(溶栓后出血评分)与使用rt-PA(0.6mg/kg体重)静脉溶栓治疗脑梗死后颅内出血情况的关系,为使用HAT指导溶栓治疗做准备。[方法]对162名进行了重组组织型纤溶酶原激活剂(rt-PA,按0.6mg/kg体重)静脉溶栓的急性前循环脑梗死患者,分别记录HAT评分的各分项评分情况,按HAT0分、1分、2分、3分和≥4分为5组,记录各组患者的溶栓后颅内出血情况(分为非症状性、症状性及致死性颅内出血)和90d后的功能结局(以改良Rankin评分,mRs表示),各组间进行比较。[结果]HAT0分、1分、2分、3分和≥4分各组的总颅内出血的百分比分别为2.7%、10.2%、20.0%、31.2%和50.0%;症状性颅内出血的比例分别为0.0%、2.0%、5.0%、12.6%和50.0%,卡方检验得χ2=28.0,P﹤0.001(Monte Carlo确切概率法),提示HAT分值的增加,颅内出血的比例及严重程度在增加,存在统计学上的差异。另外将HAT和出血类型做spearman等级相关分析,得到spearman相关系数0.306,P﹤0.001;说明HAT得分和出血程度正相关。本研究患者队列的症状性出血比例为3.1%,低于NINDS研究的5.9%。随着HAT评分的增加,取得良好预后(mRs≤2的比例)的可能性越来越小。[结论]对于按0.6mg/kg体重,时间窗为4.5h使用rt-PA进行静脉溶栓的急性脑梗死患者,HAT评分的增加与颅内出血风险的增加正相关。HAT可能作为预测溶栓后颅内出血风险的一个简单易行的实用临床工具。     

Temporal trends in the treatment of over 1.5 million patients with myocardial infarction in the US from 1990 through 1999: the National Registry of Myocardial Infarction 1, 2 and 3

OBJECTIVES

We sought to determine trends in the treatment of myocardial infarction from 1990 through 1999 in the U.S. and to relate these trends to current guidelines.

BACKGROUND

Limited data are available to show how recent clinical trials and clinical guidelines have impacted treatment of myocardial infarction.

METHODS

Temporal trends in myocardial infarction treatment and outcome were assessed by using data from 1,514,292 patients in the National Registry of Myocardial Infarction (NRMI) 1, 2 and 3 from 1990 through 1999.

Results

During this interval, the use of intravenous thrombolytic therapy declined from 34.3% to 20.8%, but the use of primary angioplasty increased from 2.4% to 7.3% (both P = 0.0001). The median “door-to-drug” time among thrombolytic therapy recipients fell from 61.8 to 37.8 min (p = 0.0001), primarily owing to shorter “door-to-data” and “data-to-decision” times. The prevalence of non–Q wave infarctions increased from 45% in 1994 to 63% in 1999 (p = 0.0001). From 1994 through 1999, there was increased usage of beta-blockers, aspirin and angiotensin-converting inhibitors, both during the first 24 h after admission and on hospital discharge (all P = 0.0001). Between 1990 and 1999, the median duration of hospital stay fell from 8.3 to 4.3 days, and hospital mortality declined from 11.2% to 9.4% (both P = 0.0001).

CONCLUSIONS

The NRMI data from 1990 through 1999 demonstrate that the recommendations of recent clinical trials and published guidelines are being implemented, resulting in more rapid administration of intravenous thrombolytic therapy, increasing use of primary angioplasty and more frequent use of adjunctive therapies known to reduce mortality, and may be contributing to the higher prevalence of non–Q wave infarctions, shorter hospital stays and lower hospital mortality.     

Factors influencing nonadministration of thrombolytic therapy in early arrival strokes in a university hospital in Hyderabad,India

Background:It is a well-known fact that very few patients of stroke arrive at the hospital within the window period of thrombolysis. Even among those who do, not all receive thrombolytic therapy.Objective:The objectives of this study were to determine the proportion of early arrival ischemic strokes (within 6 h of stroke onset) in our hospital and to evaluate the causes of nonadministration of intravenous and/or intraarterial thrombolysis in them.Results:Out of 2,593 stroke patients, only 145 (5.6%) patients presented within 6 h of stroke onset and among them 118 (81.4%) patients had ischemic stroke and 27 (18.6%) patients had hemorrhagic stroke. A total of 89/118 (75.4%) patients were thrombolyzed. The reasons for nonadministration of thrombolysis in the remaining 29 patients were analyzed, which included unavoidable factors in 8/29 patients [massive infarct (N = 4), hemorrhagic infarct (N = 1), gastrointestinal bleed (N = 1), oral anticoagulant usage with prolonged international normalized ratio (INR) (N = 1), and recent cataract surgery (N = 1)]. Avoidable factors were found for 21/29 patients, include nonaffordability (N = 7), fear of bleed (N = 4), rapidly improving symptoms (N = 4), mild stroke (N = 2), delayed neurologist referral within the hospital (N = 2), and logistic difficulty in organizing endovascular treatment (N = 2).Conclusion:One-fourth of early ischemic stroke patients in our study were not thrombolyzed even though they arrived within the window period. The majority of the reasons for nonadministration of thrombolysis were potentially preventable, such as nonaffordability, intrahospital delay, and nonavailability of newer endovascular interventions.