Acute Subdural Hematoma After Intro-arterial Thrombolysis for Acute Ischemic Stroke-Case Report-

Meguro, Toshinari; Higashi, Hisato; Nishimoto, Ken

doi:10.2176/nmc.45.627

Cited by 8 publications

(5 citation statements)

References 11 publications

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“…Clinical studies PROACT 8 and PROACT II 9 reported a high recanalization rate in intra-arterial thrombolysis (IAT) and a good outcome in ischemic cerebrovascular disease. However, the high recanalization rate was associated with intracranial hemorrhage which is the most worrying problem due to the increased mortality [9][10][11] . Urokinase was commonly used in thrombolytic treatment in developing countries because of the low price and good pharmacodynamic action.…”

Section: Introductionmentioning

confidence: 99%

Outcome in Acute Stroke with Different Intra-Arterial Infusion Rate of Urokinase on Thrombolysis

Gan

Luo

et al. 2010

Interv Neuroradiol

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Intra-arterial infusion of urokinase (UK) has been widely used. However, the optimal infusion rate of the reagent has never been determined. This was investigated in the acute stage of middle cerebral artery (MCA) embolism in the present study. Sprague Dawley male rats (n=43) were randomly divided into sham-operation and five ischemic groups with urokinase administration at different infusion rates or without urokinase administration. Ischemia was induced with MCA embolism. Two hours after embolism, total urokinase (urokinase, 170,000U/kg) was given in groups A,B,C and D (n=8 each) at different rates: 1,000 U (0.03 ml/min) per minute, 4,000U (0.12 ml/min), 10,000U (0.30 ml/min), and 16,000U (0.48 ml/min), respectively. Group E received normal saline at a rate of 0.48 ml/min. The sham-operation group (no embolism) received urokinase at (170,000U/kg, 1.5 ml, 16,000 U/min). During ischemia and thrombolysis, regional cerebral blood flow (CBF) was monitored by laser Doppler flowmetry. The neurological deficits, infarct volumes and mortalities in each group were determined. The CBF in ischemic hemisphere were significantly (p<0.05) decreased after embolism in groups A!E at similar levels (27.32±8.20% to 34.71±6.84%). After different treatments, in group B 4,000U/min infusion of UK induced the best reperfusion, the least neurological deficits and infarct volume, as well as the least mortality and lowest incidence of hemorrhage. The effect of intra-artery thrombolysis of urokinase was related to the infusion rate. Our study demonstrated an optimal infusion rate at 4,000U/min, suggesting relatively low levels of infusion are better able to improve brain reperfusion and reduce brain injury after stroke.

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Section: Introductionmentioning

confidence: 99%

Outcome in Acute Stroke with Different Intra-Arterial Infusion Rate of Urokinase on Thrombolysis

Gan

Luo

et al. 2010

Interv Neuroradiol

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“…However, their brain NCCT showed no evidence of bleeding. ICH has been describe when AIS patients with head trauma are treated with rtPA 22 .…”

Section: Discussionmentioning

confidence: 99%

Low dosis of alteplase, for ischemic stroke after Enchanted and its determinants, a single center experience

Brunser

Mazzon

Cavada

et al. 2020

Arq. Neuro-Psiquiatr.

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Background: Low-dose alteplase (LrtPA) has been shown not to be inferior to the standard-dose (SrtPA) with respect to death/disability. Objective: We aim to evaluate the percentage of patients treated with LrtPA at our center after the ENCHANTED trial and the factors associated with the use of this dosage. Methods: Prospective study in consecutive patients with an acute stroke admitted between June 2016 and November 2018. Results: 160 patients were treated with intravenous thrombolysis, 50% female; mean age 65.4±18.5 years. Of these, 48 patients (30%) received LrtPA. In univariate analysis, LrtPA was associated with patient's age (p=0.000), previous modified Rankin scale scores (mRS) (p<0.000), hypertension (p=0.076), diabetes mellitus (p=0.021), hypercholesterolemia (p=0.19), smoking (p=0.06), atrial fibrillation (p=0.10), history of coronary artery disease (p=0.06), previous treatment with antiplatelet agents (p<0.000), admission International Normalized Ratio-INR (p=0.18), platelet count (p=0.045), leukoaraiosis on neuroimaging (p<0.003), contraindications for thrombolytic treatment (p=0.000) and endovascular treatment (p=0.027). Previous relevant bleedings were determinants for treatment with LrtPA. Final diagnosis on discharge of stroke mimic was significant (p=0.02) for treatment with SrtPA. In multivariate analysis, mRS (OR: 2.21; 95%CI 1.37‒14.19), previous antiplatelet therapy (OR: 11.41; 95%CI 3.98‒32.70), contraindications for thrombolysis (OR: 56.10; 95%CI 8.81‒357.80), leukoaraiosis (OR: 4.41; 95%CI 1.37‒14.10) and diagnosis of SM (OR: 0.22; 95%CI 0.10‒0.40) remained independently associated. Conclusions: Following the ENCHANTED trial, LrtPA was restricted to 30% of our patients. The criteria that clinicians apply are based mostly on clinical variables that may increase the risk of brain or systemic hemorrhage or exclude the patient from treatment with lytic drugs.

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“…Timely recanalization of the target vessel in an acute ischemic stroke is associated with a 4- to 5-fold increase in the odds of a good clinical functional outcome and a 4- to 5-fold reduction in the odds of death [4]. Although endovascular therapy is a useful treatment option, the presence of a bleeding risk, such as intracranial hemorrhage or abnormal hemostasis, has been an exclusion criterion in decision-making regarding the use of chemical thrombolytics [2, 5]. However, the use of MT alone in patients at risk of bleeding may seem feasible and safe.…”

Section: Discussionmentioning

confidence: 99%

Safe Implementation of Mechanical Thrombectomy in Acute Stroke Patients with Major Arterial Occlusion and Concomitant Subdural Hematoma

et al. 2013

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Mechanical thrombectomy (MT) alone in cases of large-vessel acute ischemic stroke (AIS) with a concomitant subdural hematoma (SDH) seems feasible and safe, but there's still a lack of evidence in the clinical literature. We report three cases of AIS with SDH, of which MT was performed with successful recanalization and no major changes in SDH: two elderly men with acute traumatic SDH and one man with incidental chronic SDH. (1) A 67-year-old man with acute traumatic SDH in the right side developed right middle cerebral artery (MCA) stroke, (2) a 72-year-old man with chronic SDH in the left side developed right MCA stroke, and (3) a 76-year-old-man with acute traumatic SDH in the right side developed top-of-basilar artery syndrome. As for AIS patients with a SDH, MT may be the only feasible and safe treatment option.

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Acute Subdural Hematoma After Intro-arterial Thrombolysis for Acute Ischemic Stroke-Case Report-

Cited by 8 publications

References 11 publications

Outcome in Acute Stroke with Different Intra-Arterial Infusion Rate of Urokinase on Thrombolysis

Outcome in Acute Stroke with Different Intra-Arterial Infusion Rate of Urokinase on Thrombolysis

Low dosis of alteplase, for ischemic stroke after Enchanted and its determinants, a single center experience

Safe Implementation of Mechanical Thrombectomy in Acute Stroke Patients with Major Arterial Occlusion and Concomitant Subdural Hematoma

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