ABSTRACT
INTRODUCTION: This study aimed to describe and analyze the rate of clot migration of vessel thrombosis to distal segments in patients with acute ischemic stroke (AIS) who received intravenous thrombolysis (IVT) with tenecteplase (TNK) and alteplase (ALT) before mechanical thrombectomy (MT). In addition, we aimed to determine the relationship between thrombus migration and functional prognosis. METHODS: This study followed the STROBE reporting guidelines. We performed a retrospective analysis of a series of patients from November 2017 to April 2023 with an AIS with thrombosis on CT imaging, treated with IVT (TNK or ALT, split into two distinct groups) prior to mechanical thrombectomy. RESULTS: Two hundred and fifty-six patients with large vessel occlusion (LVO) were included. Ninety-six had received TNK. One hundred and sixty had received ALT. Of the 96 TNK patients, 25 experienced either complete recanalization (n = 3) or thrombus migration (n = 22). Of the 160 ALT patients, 20 experienced either complete recanalization (n = 6) or thrombus migration (n = 14). The difference being statistically substantial for the thrombus migration rate (OR = 3.61, 95% confidence interval: 1.63; 7.98). Migration to an irretrievable very distal segment occurred in four (4%) patients with TNK and in three patients (2%) with ALT (p > 0.05). Thrombus migration was not significantly associated to a different functional prognosis, measured through Rankin scale after 3 months (OR = 0.44, 95% confidence interval: 0.17; 1.12). CONCLUSION: The use of TNK over ALT as a fibrinolytic agent is associated with a higher thrombus migration rate. The migration of thrombi to distal segments, which are theoretically less accessible for mechanical thrombectomy, did not result in worse clinical outcomes.
ABSTRACT
Las tumoraciones en la mama son una de las patologías más prevalentes en las consultas de Atención Primaria desde la adolescencia hasta la vejez. El cáncer de mama es una patología que actualmente supone la causa más frecuente de cáncer en la mujer. Creemos necesario la correcta realización de una historia clínica en Atención Primaria y la utilización de herramientas para mejorar el diagnóstico y agilizar la consulta. Presentamos el caso de una mujer de 17 años que acude a la consulta de Atención Primaria por aumento de densidad en la parte superior de la mama izquierda de 3 meses de evolución cuyo diagnóstico final fue un carcinoma ductal infiltrante
Breast masses are one of the most prevalent diseases in Primary care consultations from adolescence to old age. Breast cancer is currently the most frequent cancer in women. We deem it necessary to take a proper medical history and to use tools to improve diagnosis and streamline consultations. We present the case of a 17-year-old woman who consults her primary care physician for an increased density in the upper left breast for 3 month after onset, whose final diagnosis was infiltrating ductal carcinoma
