ABSTRACT
Abstract The authors report the case of a 71-year-old woman presented to the Emergency Department with acute ischemic stroke. She was treated with rt-PA and interventional endovascular revascularization and developed rapidly progressing angioedema that led to emergency intubation. The standard treatment was not very effective and the swelling improved after infusion of fresh frozen plasma. Angioedema after rt-PA infusion could be a life-threatening emergency that requires quick airway management by skilled professionals. As this condition is triggered by several factors, such as unregulated histamine and bradykinin production, the traditional treatment recommended by the guidelines may not be sufficient and the use of FFP can be considered as a safe and valuable aid.
Subject(s)
Humans , Female , Middle Aged , Aged , Ischemic Stroke/complications , Angioedema/chemically induced , Angioedema/therapy , Plasma , Histamine , Airway ManagementABSTRACT
Objective:To investigate the efficacy and safety of recombinant tissue plasminogen activator (rt-PA) in patients with wake-up ischemic stroke (WUIS) of anterior circulation non-major arteries.Methods:Sixty-seven patients with WUIS of anterior circulation non-major arteries (time from falling asleep/last use of bathroom at night to intravenous thrombolysis≤9 h and >4.5 h) admitted to Department of Neurology, Beijing Shijingshan Hospital and Department of Neurosurgery, Beijing Muyangliu Hospital from January 1 st, 2017 to December 31 st, 2021 were chosen; these 35 patients accepted routine antiplatelet therapy after intravenous thrombolytic therapy were chosen as control group, and the other 32 patients accepted rt-PA arterial thrombolysis after intravenous thrombolytic therapy were chosen as study group. Vascular recanalization after arterial thrombolysis was observed in study group (cerebral infarction thrombolysis grading 2 and 3: good vascular recanalization). Neurological deficit improvement during treatment, clinical prognoses (modified Rankin scale scores of 0-2: good prognosis) and hemorrhagic transformation incidence 3 months after treatment were compared between the 2 groups. Results:The vascular thrombolytic recanalization rate of study group was 81.25% (26/32). Patients in study group had significantly decreased National Institute of Health stroke scale scores compared with those in control group 1, 7, and 14 d after thrombolytic therapy ( P<0.05). The good prognosis rate of study group (62.50%, 20/32) was significantly higher than that in control group (37.14%, 13/35, P<0.05). No significant difference in hemorrhagic transformation rate was noted between the 2 groups (15.6% [5/32] vs. 5.71% [2/35], P>0.05). Conclusion:Patients with WUIS of anterior circulation non-major arteries (time from falling asleep/last use of bathroom at night to intravenous thrombolysis≤9 h and >4.5 h) benefit from arterial thrombolysis with rt-PA, and risk of secondary intracerebral hemorrhage is not obviously increased.
ABSTRACT
Objective:To investigate the efficacy and safety of recombinant tissue plasminogen activator (rt-PA) intravenous thrombolysis combined with edaravone dexborneol at different timing in super elderly patients (aged≥85 years) with moderate to severe acute ischemic stroke (AIS).Methods:A prospective study was performed. Seventy-one super elderly patients with moderate to severe AIS treated with rt-PA intravenous thrombolysis combined with edaravone dexborneol from December 2020 to March 2023 in Department of Neurology, Affiliated Fourth Central Hospital of Nankai University were selected and randomly divided into early group ( n=35) and advanced group ( n=36); patients in the early group were given edaravone dexborneol immediately after rt-PA intravenous thrombolysis, and patients in the advanced group were given edaravone dexborneol 24 h after rt-PA intravenous thrombolysis. In addition, 31 patients with moderate to severe AIS received rt-PA intravenous thrombolysis only in Department of Neurology of the hospital from August 2018 to December 2020 were selected as control group. Differences in efficacy and safety indexes among the 3 groups were compared. Results:After 7 d of treatment, the improvement rate of neurological function in early group was significantly higher than that in control group and advanced group ( P<0.05). After 90 d of treatment, modified Rankin scale (mRS) scores in early group were statistically lower than those in control group and advanced group ( P<0.05); good prognosis rate in early group was statistically higher than that in control group and advanced group ( P<0.05). The incidences of intracranial hemorrhage and symptomatic intracranial hemorrhage in early group were significantly lower than those in control group and advanced group ( P<0.05). After 30 and 90 d of treatment, the advanced group had significantly lower mortality than the control group, but significantly higher mortality than the early group ( P<0.05). Conclusion:Edaravone dexborneol immediately after rt-PA intravenous thrombolysis is the optimal timing for super elderly patients with moderate to severe AIS, which can improve the efficacy and safety.
ABSTRACT
Sub?macular hemorrhage poses a potential threat to vision if left untreated. The preferred surgical technique to clear sub?macular hemorrhage includes vitrectomy followed by retinotomy using a 41G needle with subsequent injection of recombinant tissue plasminogen activator (r?tPA) followed by air/SF6 injection into the sub?retinal space. A malleable nature, increased resistance, and the cost of the 41G needle limit its use. We evaluated the safety and efficacy of a 26G needle for retinotomy as a supplement for the 41G needle in a series of six subjects with sub?macular hemorrhage. A slight modification in the procedure was done by injecting air into the sub?retinal space prior to the r?tPA injection. We found that our technique of using the 26G needle for retinotomy is safe and effective due to its stable nature and self?sealing properties. An air injection prior to r?tPA allows for increased bioavailability of the drug by preventing efflux due to its tamponading effect.
ABSTRACT
@#To compare the efficacy and safety of rt-PA and UK in the treatment of ischemic stroke （AIS） within 6 hours of onset in routine clinical practice in China. To compare the effects of rt-PA and UK on various parameters of thrombelastogram（TEG），and the relationship between various parameters of thrombelastogram and the safety of intravenous thrombolytic therapy of rt-PA and UK were compared. Methods A total of 102 AIS patients who received intravenous thrombolytic therapy of rt-PA （within 4.5 h） or UK （within 6 h） in chaohu hospital affiliated to anhui medical university from July 2018 to February 2021 were collected. including 59 patients who received rt-PA and 43 patients who received urokinase. NIHSS scores of patients on admission and before thrombolytic therapy，NIHSS scores of patients 14 days after thrombolytic therapy （or at discharge），complications of intracranial hemorrhage and digestive tract hemorrhage，and the number of deaths during hospitalization of patients in the two groups were recorded. At the same time，TEG parameters （including R，MA，K，α Angle and CI） after intravenous thrombolysis were recorded，and the indicators of R，MA，K，α Angle and CI of rt-PA group and UK group were compared and analyzed. Results There were no significant differences in neurological improvement，mortality，incidence of intracranial hemorrhage and digestive tract hemorrhage between rt-PA group and UK group （P> 0.05）. There were statistically significant differences in MA value between rt-PA group and urokinase group. The mean R value of patients with bleeding complications （bleeding group） was higher than that of non-bleeding group，and the difference was statistically significant. Conclusions Rt-PA and UK have similar efficacy and safety in AIS patients. Both rt-PA and UK can improve the prognosis of AIS patients. After intravenous thrombolysis，the hypocoagulant state of the UK group may be more significant than that of the rt-PA group，and the R time of the bleeding group is longer than that of the non-bleeding group，which has a certain predictive effect on the hemorrhage of acute cerebral infarction after intravenous thrombolysis.
ABSTRACT
Objective:To investigate the effects of Danhong injection combined with intravenous recombinant tissue plasminogen activator (rt-PA) on cardiac function, myocardial zymogram and lipoprotein associated phospholipase A2 (Lp-PLA2) level in older adult patients with acute myocardial infarction (AMI). Methods:Eighty older adult patients with acute myocardial infarction who received treatment in Community-based General Hospital of Shaoxing Central Hospital, China between January 2017 and December 2019 were included in this study. They were randomly assigned to receive either intravenous thrombolysis with rt-PA (control group, n = 40) or Danhong injection combined with intravenous thrombolysis with rt-PA (observation group, n = 40). The changes in traditional Chinese medicine syndrome score, left ventricular ejection fraction, left ventricular end diastolic diameter, creatine kinase, creatine kinase-MB and lipoprotein associated phospholipase A2 level as well as adverse cardiovascular events were compared between the control and observation groups. Results:After treatment, the score of chest tightness, dark purple tongue, palpitation and shortness of breath in the two groups were decreased. After treatment, the score of chest tightness, dark purple tongue, palpitation and shortness of breath in the observation group was (2.13 ± 0.31) points, (1.98 ± 0.41) points, (1.77 ± 0.29) points, respectively, which was significantly lower than that in the control group [(2.98 ± 0.37) points, (2.52 ± 0.56) points, (2.13 ± 0.32) points, t = 11.137, 4.920, 5.272, all P < 0.001]. After treatment, left ventricular end diastolic diameter in each group was decreased compared with before treatment. After treatment, left ventricular end diastolic diameter in the observation group was significantly lower than that in the control group [(46.12 ± 4.11) mm vs. (49.74 ± 4.32) mm], and left ventricular ejection fraction in the observation group was significantly higher than that in the control group [(47.02 ± 3.55) % vs. (43.25 ± 4.10) %, t = 3.839, 4.396, both P < 0.001). After treatment, Lp-PLA2, creatine kinase, creatine kinase-MB levels in each group were decreased compared with before treatment. After treatment, Lp-PLA2, creatine kinase, creatine kinase-MB levels in the observation group were (171.02 ± 12.52) μg /L, (10.52 ± 2.11) U/L, (24.12 ± 3.52) U/L), respectively, which were significantly lower than those in the control group [(189.63 ± 11.98) μg/L, (14.71 ± 2.62) U/L, (32.79 ± 4.79) U/L), t = 6.792, 7.877, 9.224, all P < 0.001]. The incidence of adverse cardiovascular events in the observation group was significantly lower than that in the control group (5.00% vs. 22.50%, χ2 = 5.165, P < 0.05). Conclusion:Danhong injection combined with intravenous rt-PA for the treatment of acute myocardial infarction in older adult patients can greatly decrease traditional Chinese medicine syndrome score, improve cardiac function, regulate myocardial zymogram and Lp-PLA2 levels, and decrease the incidence of adverse cardiovascular events.
ABSTRACT
To study the effect of modified Buyang Huanwu Decoction on the hemorrhagic transformation after intravenous thrombolysis of recombinant tissue type plasminogen activator(rt-PA) in patients with super early(onset time<4. 5 h) cerebral infarction. From March 2016 to July 2018,at the brain disease zone of the First Affiliated Hospital of Henan University of Traditional Chinese Medicine,212 cases of super early cerebral infarction were selected and divided into two group according to the randomized complete blocks designs: control group(106 cases) and traditional Chinese medicine group(106 cases). The control group was treated with rt-PA intravenous thrombolysis,while the traditional Chinese medicine group was treated with modified Buyang Huanwu Decoction in addition to the therapy of the control group. Both groups were treated for 14 days. Neurological deficit score,serum matrix metalloproteinase-9(MMP-9),neuron specific enolase(NSE),vascular endothelial growth factor(VEGF) and plasma cellular fibronectin(c-FN) levels,the incidence of hemorrhagic transformation,clinical efficacy and adverse drug reactions before and after treatment were compared between the two groups. According to the findings,at the 14 thday after treatment,the rank sum test of the grade data showed that the clinical efficacy of the traditional Chinese medicine group was better than that of the control group(Z =-2. 033,P = 0. 042); on the basis of χ2 test,the total efficiency of the traditional Chinese medicine group was higher than that of the control group(χ2= 4. 895,P =0. 027); the hemorrhagic transformation rate of the traditional Chinese medicine group was lower than that of the control group within14 days of treatment(χ2= 3. 962,P = 0. 047). MMP-9 levels in the traditional Chinese medicine group were lower than those in the control group at the 3 rd,5 th,7 th,10 th,14 thd after treatment(t =-2. 474,-3. 022,-5. 163,-6. 998,-9. 821; P = 0. 014,0. 003,0,0,0). The improvement of c-FN,NSE,VEGF and NIHSS scores in the traditional Chinese medicine group was superior to that of the control group after 14 days of treatment(t =-2. 343,-3. 187,-2. 129,-3. 105; P = 0. 020,0. 002,0. 034,0. 002). No obvious adverse reactions of modified Buyang Huanwu Decoction were observed during 14 days of treatment. Modified Buyang Huanwu Decoction could reduce the expressions of MMP-9,c-FN,NSE and VEGF after rt-PA intravenous thrombolysis in patients with super early cerebral infarction,and decrease the hemorrhagic transformation rate after thrombolysis,with high safety.
Subject(s)
Humans , Cerebral Infarction , Drug Therapy , Drugs, Chinese Herbal , Therapeutic Uses , Fibronectins , Blood , Matrix Metalloproteinase 9 , Blood , Medicine, Chinese Traditional , Phosphopyruvate Hydratase , Blood , Recombinant Proteins , Therapeutic Uses , Thrombolytic Therapy , Tissue Plasminogen Activator , Therapeutic Uses , Vascular Endothelial Growth Factor A , BloodABSTRACT
Resumen El factor de riesgo más importante para presentar una enfermedad cerebrovascular (EVC) es la edad. El ictus es la causa más frecuente de discapacidad adquirida en la edad adulta. De acuerdo con la Organización Mundial de la Salud, se estima que en el año 2050, casi la mitad de la población mayor de 65 años podría sufrir o haber sufrido un EVC. Debido a la gran incidencia y al impacto negativo que tiene esta enfermedad, presentamos el caso clínico de una trombólisis exitosa en una paciente con ictus isquémico y crisis hipertensiva en el Servicio de Urgencias. Ponemos de manifiesto la adecuada evaluación con las diferentes escalas existentes, clínicas, radiológicas y pronósticas (NIHSS, Dragon Score, ASPECT, HAT score), así como los criterios de inclusión y exclusión, los cuales son indispensables para administrar una terapia de repercusión intravenosa. Conclusiones En México, los casos reportados con trombólisis exitosa son sólo el 5%. En este caso de éxito, la adecuada actuación en el Servicio de Urgencias de primer contacto impactó de manera positiva en el pronóstico de la paciente, ya que el diagnóstico oportuno y la administración de rTPA (activador tisular del plasminógeno) evitó secuelas importantes y consiguió una mejor calidad de vida -la cual se ve disminuida hasta en 70% de los pacientes que sufren un EVC (según estudios realizados en los EUA)-.
Abstract The most important risk factor for presenting a cerebrovascular disease (CVA) is age. Stroke is also the most frequent cause of disability acquired in adulthood. According to the World Health Organization, it is estimated that by the year 2050, almost half of the population over 65 could suffer or have suffered a CVA. Due to the high incidence and negative impact of this disease, we present a clinical case of successful thrombolysis in a patient with ischemic stroke and hypertensive crisis in the emergency department. We emphasize the adequate evaluation with the different existing clinical, radiological and predictive scales (NIHSS, Dragon Score, ASPECT, HAT score), as well as the inclusion and exclusion criteria, which are indispensable to administer an intravenous reperfusion therapy. Conclusions In Mexico, the cases reported with successful thrombolysis are only 5%. In this successful case, the proper performance in the emergency service impacted positively on the prognosis of the patient, since the timely diagnosis and administration of rTPA avoided important sequelae and provided a better quality of Life, which is decreased in up to 70% of patients suffering from a CVA (according to studies conducted in the USA).
ABSTRACT
Background: Stroke is one of the common causes of mortality and disability. By introducing r-TPA into the global drug market and its effect on the patients’ prognosis, using this drug is recommended in all patients with ischemic stroke who visited less than 4.5 hours after stroke and do not have contraindications. The aim of this study was to investigate the frequency of stroke patients qualified for recombinant tissue plasminogen activator (r-TPA) and its limtations.Methods: In this descriptive cross-sectional study, 244 patients examined with stroke admitted to the Neurology Department of Zahedan city hospital in 2016. Information form were completed with demographic data, transmission method, referral time, CT scan preparation time, and the response of the patients' trials, and finally the data were inserted in SPSS.16 software and analysed by statistical methods.Results: Out of all patients with ischemic stroke, 28 (11.5%) patients had contraindication to receive drug. Of 216 remain patients, 201 patients (93.1%) had no possibility to receive r-TPA due to the loss of golden time and only 15 patients (6.9%) had possibility to receive drug because of visited 4.5 hours before the beginning of symptoms. Of them, 3 (20%) patients due to delay in CT scan and test results, had no possibility to receive r-TPA. In summary, of all patients with inclusion criteria, only 12 (5.5%) patients could use the r-TPA in this study.Conclusions: The most important barrier to using r-TPA has been the loss of golden time and training to raise awareness of the society can lead to early referral from the onset of stroke symptoms.
ABSTRACT
Minor stroke is a common type of acute ischemic stroke. Early large-scale thrombolytic studies regarded minor stroke as a contraindication of intravenous thrombolysis. In recent years, more and more retrospective studies have shown that some minor stroke patients can still benefit from intravenous thrombolysis. Some studies are starting to identify patients who are more likely to be treated with thrombolysis, but there is still a lack of evidence-based evidence. This article summarizes the thrombolytic study of minor stroke, hoping to provide some references for nerve physicians.
ABSTRACT
Background: Although acute pancreatitis is listed among the exclusion criteria for the administration of recombinant tissue plasminogen activator according to the Japanese Guideline for the Management of Stroke, the co-occurrence of acute pancreatitis and acute ischemic stroke has not been investigated. The present study aimed to assess the incidence rate of acute pancreatitis in patients with acute ischemic stroke.Methods: This study consecutively enrolled all patients with ischemic stroke admitted to the Department of Neurology, JA Toride Medical Center between April 2014 and March 2016. Diagnosis of acute pancreatitis was made according to the revised Atlanta Classification of Acute Pancreatitis. We retrospectively analyzed serum amylase activity and the frequency of acute pancreatitis as a comorbidity of ischemic stroke.Results: A total of 411 ischemic stroke patients were included. Serum amylase activity was measured for 364 patients, 27 of whom presented with amylase activity exceeding the upper limit of normal. In two patients with serum amylase activity greater than three times-fold the upper limit of normal, computed tomography or transabdominal ultrasonography showed no characteristic findings of acute pancreatitis. No patient in the cohort met the diagnostic criteria for acute pancreatitis.Conclusions: Acute pancreatitis is a very rare comorbidity of acute ischemic stroke.
ABSTRACT
Acute ischemic stroke (AIS) has the characteristics of high morbidity, disability and mortality. Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) for AIS in time window is an effective treatment recommended by domestic and overseas guidelines. However, intravenous thrombolysis has shortcomings, such as short time window, low recanalization rate and high risk of bleeding. Therefore, in recent years, studies on prolonging the time window, using low-dose rt-PA or a new generation of thrombolytic agent, and thrombolysis combined with anti-thrombotic therapy have been carried out worldwide. Based on the studies on intravenous thrombolysis, this paper discusses several issues, including extending time window, low-dose rt-PA thrombolysis, and new generation of thrombolytic agent.
ABSTRACT
The efficacy and safety of recombinant tissue plasminogen activator (rtPA) need to be improved due to its low bioavailability and requirement of large dose administration.The purpose of this study was to develop a fibrin-targeted nanoparticle (NP) drug delivery system for thrombosis combination therapy.We conjugated rtPA to poly(ethylene glycol)-poly(ε-caprolactone) (PEG-PCL) nanoparticles (rtPA-NP) and investigated its physicochemical characteristics such as particle size,zeta potential,enzyme activity of conjugated rtPA and its storage stability at 4℃.The thrombolytic activity of rtPA-NP was evaluated in vitro and in vivo as well as the half-life of rtPA-NP,the properties to fibrin targeting and its influences on systemic hemostasis in vivo.The results showed that rtPA-NP equivalent to 10％ of a typical dose of rtPA could dissolve fibrin clots and were demonstrated to have a neuroprotective effect after focal cerebral ischemia as evidenced by decreased infarct volume and improved neurological deficit (P＜0.001).RtPA-NP did not influence the in vivo hemostasis or coagulation system.The half-life of conjugated rtPA was shown to be approximately 18 times longer than that of free rtPA.These experiments suggested that rtPA-conjugated PEG-PCL nanoparticles might be a promising fibrin-targeted delivery system for a combination treatment of thrombosis.
ABSTRACT
The efficacy and safety of recombinant tissue plasminogen activator (rtPA) need to be improved due to its low bioavailability and requirement of large dose administration.The purpose of this study was to develop a fibrin-targeted nanoparticle (NP) drug delivery system for thrombosis combination therapy.We conjugated rtPA to poly(ethylene glycol)-poly(ε-caprolactone) (PEG-PCL) nanoparticles (rtPA-NP) and investigated its physicochemical characteristics such as particle size,zeta potential,enzyme activity of conjugated rtPA and its storage stability at 4℃.The thrombolytic activity of rtPA-NP was evaluated in vitro and in vivo as well as the half-life of rtPA-NP,the properties to fibrin targeting and its influences on systemic hemostasis in vivo.The results showed that rtPA-NP equivalent to 10％ of a typical dose of rtPA could dissolve fibrin clots and were demonstrated to have a neuroprotective effect after focal cerebral ischemia as evidenced by decreased infarct volume and improved neurological deficit (P＜0.001).RtPA-NP did not influence the in vivo hemostasis or coagulation system.The half-life of conjugated rtPA was shown to be approximately 18 times longer than that of free rtPA.These experiments suggested that rtPA-conjugated PEG-PCL nanoparticles might be a promising fibrin-targeted delivery system for a combination treatment of thrombosis.
ABSTRACT
Objective To observe the effect of early using butylphthalide injection before and after thrombolytic therapy with intravenous recombinant tissue plasminogen activator (rt-PA) on the clinical prognosis of patients with ultra-early acute cerebral infarction (ACI). Methods A prospective study was conducted, 81 patients with ACI admitted to the Department of Neurology of Tangshan Worker's Hospital from September 2014 to March 2016 were enrolled, and they were divided into a control group (40 cases) and an observation group (41 cases) according to the random number table. Both groups were given routine treatments, such as drugs for lowering blood pressure and blood sugar, decreasing blood lipid to stabilize plaque, neuroprotection, activating blood circulation and removing blood stasis, etc. On the basis of conventional treatment, the control group was directly treated with rt-PA intravenous (IV) thrombolytic therapy according to the guidelines of thrombolytic therapy; in the observation group, the patients immediately underwent CT head examination after admission to decide whether the thrombolytic therapy was necessary, if the therapy was decided to be done, during doctors waiting for the laboratory results or transferring patients, IV drip of butylphthalide sodium chloride 100 mL. After IV drip thrombolytic therapy, if the disease condition was stabilized, the head CT was re-examined to exclude intracranial hemorrhage, if no such hemorrhage, IV drip of butylphthalide sodium chloride 100 mL was continuously given, twice daily for consecutive 14 days with the interval between the two times of IV drip being 7 hours daily. When patient's condition was changed, the re-examination of head CT could be done at any time; if the patient's condition was not changed, the head CT was routinely performed 24 hours after IV drip thrombolysis. After exclusion of intracranial hemorrhage, the patients in both groups were treated additionally by the platelet aggregation drug on the basis of their original treatment. The National Institutes of Health Stroke Scale (NIHSS) scores, Bartherl index (BI) scores were recorded before and after treatment, and the recovery situation of neurological function, hemorrhage conversion rate, mortality and adverse reactions were observed after thrombolysis. Results After treatment, the NIHSS scores were lower, and the BI index scores were higher than those before treatment in the two groups, and the change in the observation group after 14 days of treatment was more significant (NIHSS score: 3.87±3.46 vs. 7.37±4.18, BI score: 87.38±9.34 vs. 75.67±8.05, both P < 0.05); the total effective rate of the observation group was significantly higher than that of the control group [73.2% (30/41) vs. 55.0% (22/40), P < 0.05], the rate of bleeding conversion rate was lower than that of the control group [2.4% (1/41) vs. 7.5% (3/40), P < 0.05], the difference in fatality rate between the two groups was not statistically significant [2.4% (1/41) vs. 2.5% (1/40), P > 0.05]. Conclusion The clinical therapeutic effect of butylphthalide injection is relatively good for treatment of patients with ultra-early ACI.
ABSTRACT
Objective To observe the effect of early using butylphthalide injection before and after thrombolytic therapy with intravenous recombinant tissue plasminogen activator (rt-PA) on the clinical prognosis of patients with ultra-early acute cerebral infarction (ACI). Methods A prospective study was conducted, 81 patients with ACI admitted to the Department of Neurology of Tangshan Worker's Hospital from September 2014 to March 2016 were enrolled, and they were divided into a control group (40 cases) and an observation group (41 cases) according to the random number table. Both groups were given routine treatments, such as drugs for lowering blood pressure and blood sugar, decreasing blood lipid to stabilize plaque, neuroprotection, activating blood circulation and removing blood stasis, etc. On the basis of conventional treatment, the control group was directly treated with rt-PA intravenous (IV) thrombolytic therapy according to the guidelines of thrombolytic therapy; in the observation group, the patients immediately underwent CT head examination after admission to decide whether the thrombolytic therapy was necessary, if the therapy was decided to be done, during doctors waiting for the laboratory results or transferring patients, IV drip of butylphthalide sodium chloride 100 mL. After IV drip thrombolytic therapy, if the disease condition was stabilized, the head CT was re-examined to exclude intracranial hemorrhage, if no such hemorrhage, IV drip of butylphthalide sodium chloride 100 mL was continuously given, twice daily for consecutive 14 days with the interval between the two times of IV drip being 7 hours daily. When patient's condition was changed, the re-examination of head CT could be done at any time; if the patient's condition was not changed, the head CT was routinely performed 24 hours after IV drip thrombolysis. After exclusion of intracranial hemorrhage, the patients in both groups were treated additionally by the platelet aggregation drug on the basis of their original treatment. The National Institutes of Health Stroke Scale (NIHSS) scores, Bartherl index (BI) scores were recorded before and after treatment, and the recovery situation of neurological function, hemorrhage conversion rate, mortality and adverse reactions were observed after thrombolysis. Results After treatment, the NIHSS scores were lower, and the BI index scores were higher than those before treatment in the two groups, and the change in the observation group after 14 days of treatment was more significant (NIHSS score: 3.87±3.46 vs. 7.37±4.18, BI score: 87.38±9.34 vs. 75.67±8.05, both P < 0.05); the total effective rate of the observation group was significantly higher than that of the control group [73.2% (30/41) vs. 55.0% (22/40), P < 0.05], the rate of bleeding conversion rate was lower than that of the control group [2.4% (1/41) vs. 7.5% (3/40), P < 0.05], the difference in fatality rate between the two groups was not statistically significant [2.4% (1/41) vs. 2.5% (1/40), P > 0.05]. Conclusion The clinical therapeutic effect of butylphthalide injection is relatively good for treatment of patients with ultra-early ACI.
ABSTRACT
Objective:To analyze the clinical characteristics of the patients with hyperthyroidism complicated with acute cerebral infarction, and to evaluate the prognosis and safety of intravenous thrombolysis treatment in the patients with hyperthyrodism complicated with acute cerebral infarctron within time window for thrombolysis. Methods:The clinical materials of patients with acute cerebral infarction treated with intravenous tissue plasminogen activator (rt-pA)were retrospectively analyzed.All patients were divided into hyperthyroidism group (n=41) and non-hyperthyroidismin group (n=160) according to whether complicated with hyperthyroidism.The general imformation,the area of cerebral infarction and intracranial hemorrhage of the patients in two groups were analyzed.Results:The NHISS score of the patients in hyperthyroidism group was higher than that in non-hyperthyroidism group for the first time(P0.05).The proportions of the different infarction sizes had significant differences between two groups (P 0.05).Conclusion:The patients with acute cerebral infarction complicated with hyperthyroidism could benefit from intravenous thrombolysis, without the increasing of incidence of spontaneous intracranial hemorrhage (sICH) and SHA.
ABSTRACT
Objective The goal of this study is to compare the prognosis of recombinant tissue plasminogen activator (rt-PA) thrombolysis for middle cerebral artery (MCA) occlusion with patients with good and poor cerebral collateral circulation.Methods This retrospective study included 49 patients diagnosed with acute MCA occlusion and treated with rt-PA in the First Affiliated Hospital of Nanjing Medical University between October 1,2014 and February 1,2016.Patients were divided into good collaterals group (n =31) and poor collaterals group (n =18) according to their distribution of leptomeningeal arteries with CTA.Thirty day mortality rate,the incidence of symptomatic intracranial hemorrhage,24h and 30 day Stroke scores with National Institute of Health Stroke Scale (NIHSS) were compared between the two groups.Corrected chi-squared test,Fisher's exact test,or t test was used to statistical analysis as appropriate.Results The 30 day mortality rate of good collaterals group was significantly lower than that of poor collaterals group (0％ vs.16.7％,P ＜ 0.05).There were no significant differences in the incidence of symptomatic intracranial hemorrhage and 24h NIHSS score between the two groups (P ＞ 0.05),however,30 day NIHSS score of good collaterals group was significantly lower than that of poor collaterals group (7.2 ± 3.1 vs.9.6 ± 2.7,P ＜ O.05).Conclusion For patients with MCA occlusion and receiving intravenous thrombolysis,good cerebral collateral circulation may reduce their mortality and improve their clinical outcome after thrombolysis.However,good cerebral collateral circulation does not reduce the risk of symptomatic intracranial hemorrhage in those patients.
ABSTRACT
Objective To study the clinical efficacy of intra-arterial thrombolysis with recombinant tissue plasminogen activator (rt-PA) for the treatment of ischemic cerebrovascular disease caused by cerebral thrombosis. Methods A total of 245 patients accepted by our hospital during May 2013 and July 2015 were divided into the observation group (n=148) and the control group (n=97). All patients were given conventional process for controling blood pressure and blood lipids. Patients in observation group received intra-arterial thrombolysis with rt-PA, while patients in control group accepted conventional treatment. At the time of admission, the demographic characteristic, vascular influencing factors, baseline clinical findings, laboratory findings and neurological deficits were collected. The improvement of neurological function was evaluated by the modified Rankin scale 3 months after treatment. The levels of fibrinogen (FIB), D-Dimer, activated partial thromboplastin time (APTT) and thrombin time (PT) were measured before and 24 h after the treatment. Results There were no significant differences in demographic characteristic and general clinical data between the two groups ( P>0.05). The proportion of patients with improved neurological function was significantly higher in observation group than that of the control group (83.11％vs. 53.61％, P0.05). Twenty-four hours after the treatment, the levels of FIB, D-Dimer, APTT and PT were significantly improved in the observation group compared with those before treatment. The level of FIB was significantly decreased, D-Dimer was significantly increased, APTT and PT were significantly prolonged in observation group compared with those of control group (P<0.05). Conclusion The rt-PA can effectively dissolve thrombosis and correct the coagulation system and fibrinolytic system.
ABSTRACT
Objective To observe the curative effect and safety of recombinant tissue plasminogen acti-vator (rt-PA) in acute ischemic stroke (AIS) patients in more than 15 points of NIHSS scores and less than 4.5 h in onset time. Methods One hundred and twenty-seven cases with AIS in more than 15 points of NIHSS scores and less than 4.5 h in onset time were included into the study. According to the patients′ option to accept the intravenous thrombolytic therapy , 68 patients received intravenous thrombolysis with alteplase as the treat-ment group, 59 patients did not receive intravenous thrombolytic therapy as the control group. The incidence of intracerebral hemorrhage and mortality were observed in the two groups after thrombolytic therapy. Their nerve function defect was scored according to the NIHSS scores before and after treatment at day 7 and day 30. Their living ability was assessed by mRS in modified Rankin chart after the treatment at the day 90. Results The NIHSS scores were significant lower in the 2 groups after therapy (P 0.05). Conclusion Intravenous rt-PA thrombolytic therapy is effective and safe for AIS whose NIHSS scores are more than 15 points and onset time are less than 4.5 h.