Prognostic factors of acute cardiogenic ischemic stroke patients treated with alteplase intravenous thrombolysis / 第二军医大学学报

Objective To explore the prognostic influencing factors of acute cardiogenic ischemic stroke patients treated with alteplase intravenous thrombolysis. Methods Ninety-one patients with acute cardiogenic ischemic stroke, who received intravenous thrombolysis with alteplase in Stroke Center of Changhai Hospital of Navy Medical University (Second Military Medical University) between Sep. 2013 and Sep. 2017, were included in this study. The modified Rankin scale (mRS) score at 3 months after thrombolysis was used as an prognostic indicator, and the patients with mRS score≤2 were good prognosis group (n＝54) and those with mRS score 3-6 were poor prognosis group (n＝37). The age, gender, medical history, baseline National Institutes of Health stroke scale (NIHSS) score, baseline Glasgow coma scale (GCS) score and Alberta stroke program early computed tomograghy score (ASPECTS) before thrombolysis were analyzed in each group. Multivariate logistic regression analysis was used to analyze the prognostic influencing factors. Results The good prognosis rate was 59.3% (54/91) at 3 months after thrombolysis. There were significant differences in age ([66.57±13.46] years vs [75.95±6.06] years), incidence of patent foramen ovale (11.1% [6/54] vs 0.0% [0/37]), baseline NIHSS score (7.5 [3.5, 13.0] vs 18.0 [13.0, 22.0]), baseline GCS score (14.5 [12.0, 15.0] vs 10.0 [8.0, 14.0]), ASPECTS before thrombolysis (10.0 [9.0, 10.0] vs 9.0 [8.0, 10.0]) and incidence of symptomatic intracranial hemorrhage (SICH, 1.9% [1/54] vs 32.4% [12/37]) between the good and poor prognosis groups (t＝3.964, χ2＝4.401, Z＝5.235, Z＝4.079, Z＝2.519, χ2＝16.768; all P0.05). Multivariate logistic regression analysis showed that age (odds ratio [OR]＝3.236, 95% confidence interval [CI] 1.077-9.709, P＝0.036), baseline NIHSS score (OR＝2.874, 95% CI 1.074-6.329, P＝0.034) and SICH (OR＝9.346, 95% CI 1.017-83.333, P＝0.048) were influencing factors for poor prognosis of acute cardiogenic ischemic stroke patients treated with intravenous thrombolysis. Conclusion The age, baseline NIHSS score and SICH are independent factors for poor prognosis of patients with acute cardiogenic ischemic stroke. The patients with elder age, more serious stroke or SICH may have a worse prognosis.

Tratamiento trombolítico del ictus isquémico agudo / Thrombolytic therapy of the ischemic stroke

El tratamiento trombolítico ha producido un cambio positivo en la actitud de los clínicos ante los pacientes con ictus isquémico agudo. Un modesto beneficio de un 13% contrasta con un aumento del 10% en la ocurrencia de hemorragia intracerebral sintomática. Sin embargo, la mortalidad no es diferente entre los pacientes que reciben el agente trombolítico rt-PA y los que reciben placebo. Se continua estudiando la ventana terapéutica extendida actualmente hasta 4,5 horas de iniciado el evento y la organización de la atención que permita beneficiar a un mayor número de pacientes, pues por varias razones solo son elegibles en promedio 3%. Se revisan los estudios más relevantes sobre la trombólisis especialmente intravenosa: el NINDS, el ECAS III, el IST-3 y el DIDAS y DEDAS. Se describen las principales complicaciones de este tipo de terapia: la hemorragia intracerebral sintomática, otros tipos de hemorragias, angioedema y ruptura miocárdica

Thrombolytic therapy has positively changed the attitude of clinicians to treat patients with acute ischemic stroke. Treated patients were 13% more likely to achieve a recover with no significant disability after 3 month. This benefit was achieved at the cost of a 10% increase in the rate of symptomatic intracranial hemorrhage. However, this increase did not result in a higher rate of death or severe disability in the treated group. Intravenous rt-PA can be given with significant but decreasing benefit and an acceptable risk to benefit ratio up to 4,5 hours as therapeutic window. Thrombolytic therapy remains substantially underused. Most relevant trials which deal with thrombolytic therapy: NINDS, ECAS III, IST-3, DIDAS andDEDAS, are analyzed. The most frequent complications of this therapy are described

Intravenous - Thrombolysis in a 90 year Old.

Intravenous thrombolysis in acute ischemic stroke has been conventionally avoided in the elderly (>80years of age) with fear of higher incidence of complications like symptomatic intracranial hemorrhage (SICH) and possible loss of efficacy of thrombolysis in view of lack of evidence with most previous trials excluding this group of patients. There has been recent evidence suggesting benefit of IV thrombolysis in the elderly (>80 years) especially when treated within 3 hours of stroke onset. We report a successful thrombolysis in a 90 years old lady which to our knowledge is the first successful thrombolysis reported from India.

Analysis of multi-factors affecting symptomatic intracranial hemorrhage in intraarterial thrombolysis with urokinase for acute ischemic stroke / 介入放射学杂志

Objective To explore the causes and preventive measures of symptomatic intracranial hemorrhage in 217 patients with acute cerebral ischemic stroke treated with local intra-arterial urokinase. Methods From February1999 to June 2004, 217 patients were treated for acute ischemic stroke with local intra-arterial urokinase in our hospital. Factors associated with symptomatic intracranial hemorrhage of intra-arterial thrombolysis were analyzed by Stepwise logistic regression to identify some factors relating the prediction symptomatic intracranial hemorrhage. Results Symptomatic intracranial hemorrhage occurred in 8 cases (3.7%). Predictors of the symptomatic intracranial hemorrhage were the elevated systolic blood pressure before therapy (odds ratio, 1.096; 95% CI, 1.006 to 1.194) and urokinase (UK) treatment (odds ratio , 1.068; 95% CL, 1.053 to 1.247). Risk of secondary symptomatic intracranial hemorrhage was increased with elevated systolic blood pressure. Other factors like age, initial treating time, NIHSS, diabetes and collateral circulation did not predict the symptomatic intracranial hemorrhage respectively. Conclusions Predictors of symptomatic intracranial hemorrhage after local intra-arterial infusion of urokinase for acute ischemic stroke were the elevated systolic blood pressure before therapy and urokinase (UK) treatment.