Hyper-acute Stroke Patients Associated with Aortic Dissection

Iguchi, Yasuyuki; Kimura, Kazumi; Sakai, Kenichiro; Matsumoto, Noriko; Aoki, Junya; Yamashita, Shinji; Shibazaki, Kensaku

doi:10.2169/internalmedicine.49.3026

Cited by 50 publications

(32 citation statements)

References 15 publications

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“…The chest X-ray was normal in one AAD patient (Case 4), and carotid ultrasonography de- tected an intimal flap in all cases. These results were compatible with past studies that showed that chest X-rays were normal in up to 20% of AAD patients [20,21] and that carotid ultrasonography had high sensitivity for detecting AAD in patients presenting with ischemic stroke [4,22] . Simple neck ultrasound evaluation within minutes could detect AAD in patients with hyperacute stroke, without increasing the 'door-to-needle' time [22] .…”

Section: Clinical Features Of Aad Patients In Whom Acute Stroke Was Ssupporting

confidence: 93%

“…This percentage was similar to the one determined by the previous report that showed that 1% of AIS subjects presenting within 3 h from onset had AAD [4] . However, the prevalence of AAD among all individuals transferred to the ED due to suspected acute stroke was not well known.…”

Section: Frequency Of Aad In Suspected Acute Stroke Patientssupporting

confidence: 90%

“…All other aortic dissections are classified as Stanford type B, which rarely causes AIS. Prompt diagnosis is sometimes difficult, and patients with AAD could be initially misdiagnosed as having acute myocardial infarction (AMI), pulmonary embolism (PE), or AIS [3][4][5][6] . Identification of AAD in suspected AIS patients in the acute phase is especially challenging because AAD patients with neurological symptoms less commonly complain of typical chest pain than those without neurological symptoms [7] , and the time window for thrombolysis is narrower in AIS than in AMI or PE [8] .…”

Section: Introductionmentioning

confidence: 99%

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Frequency and Detection of Stanford Type A Aortic Dissection in Hyperacute Stroke Management

Sakamoto¹,

Koga²,

Ohara³

et al. 2016

Cerebrovasc Dis

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Background and Purpose: Acute Stanford type A aortic dissection (AAD) is a devastating aortic disease, and prompt diagnosis is sometimes difficult to make. Identification of AAD in suspected acute stroke patients is especially challenging. Nevertheless, the frequencies and predictive factors of AAD in suspected acute stroke patients have not been well investigated. The aim of this study was to elucidate the prevalence of and predictors for AAD in patients with suspected acute stroke. Methods: From January 2012 through January 2013, consecutive patients who visited our emergency department (ED) due to suspected acute (<24 h from onset) stroke were retrospectively enrolled. Clinical parameters including systolic blood pressure (SBP) and laboratory data were collected. Frequency of AAD in suspected acute stroke patients and acute ischemic stroke (AIS) subjects were assessed, and factors associated with AAD among AIS patients were investigated. Results: A total of 1,637 patients were included in this study. Five patients (0.31%, 95% CI 0.04-0.57) were diagnosed as having AAD. The prevalence of AAD in all AIS individuals during the study period was 1.09% (95% CI 0.14-2.05), and AAD accounted for 1.70% (95% CI 0.05-3.36) of AIS patients who appeared at the hospital within 4 h from onset. Most AAD patients presented with disturbed consciousness, and none of the AAD patients complained of chest pain. Neck ultrasonography detected an intimal flap in AAD patients. Two AAD cases died soon after ED arrival. The remaining 3 were promptly diagnosed as having AAD in the ED and underwent emergency surgery; all were discharged with only mild neurological symptoms. Low SBP in the right arm (cut-off value ≤110 mm Hg, sensitivity 100%, specificity 94.4%) and high D-dimer level (cut-off value ≥5.0 μg/ml, sensitivity 100%, specificity 91.7%) had high predictive values for detecting AAD in patients with AIS presenting within 4 h from onset. Conclusions: AAD was seen in 0.31% of suspected acute stroke patients and 1.70% of AIS patients presenting within 4 h from onset. AAD patients who were initially suspected as having acute stroke had severe neurological symptoms, including disturbance of consciousness, did not complain of typical chest pain, and when emergency surgery was performed, favorable neurological and survival outcomes were achieved. Low SBP in the right arm and high D-dimer level could predict AAD.

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Section: Clinical Features Of Aad Patients In Whom Acute Stroke Was Ssupporting

confidence: 93%

Section: Frequency Of Aad In Suspected Acute Stroke Patientssupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

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Frequency and Detection of Stanford Type A Aortic Dissection in Hyperacute Stroke Management

Sakamoto¹,

Koga²,

Ohara³

et al. 2016

Cerebrovasc Dis

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“…A paucity of cases reported in the literature deal with this issue; the majority favor avoiding the use intravenous alteplase in the setting of aortic dissection. [415][416][417] When intravenous alteplase was administered in the setting of acute stroke, some patients developed symptoms such as flank pain, 414 chest and ear pain, 418 or a cold extremity with no palpable pulse. 419 Further imaging revealed aortic dissection in each case.…”

Section: Demaerschalk Et Al Intravenous Alteplase In Acute Ischemic Smentioning

confidence: 99%

Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

Demaerschalk¹,

Kleindorfer²,

Adeoye³

et al. 2016

Stroke

586

237

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Purpose-To critically review and evaluate the science behind individual eligibility criteria (indication/inclusion and contraindications/exclusion criteria) for intravenous recombinant tissue-type plasminogen activator (alteplase) treatment in acute ischemic stroke. This will allow us to better inform stroke providers of quantitative and qualitative risks associated with alteplase administration under selected commonly and uncommonly encountered clinical circumstances and to identify future research priorities concerning these eligibility criteria, which could potentially expand the safe and judicious use of alteplase and improve outcomes after stroke. Methods-Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge and, when appropriate, formulated recommendations using standard American Heart Association criteria. All members of the writing group had the opportunity to comment on and approved the final version of this document. The document underwent extensive American Heart Association internal peer review, Stroke The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on September 24, 2015, and the American Heart Association Executive Committee on October 5, 2015. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@ wolterskluwer.com.The online-only Data Supplement, which contains literature search strategies and Figures A, B, and C, is available with this article at http://circ. ahajournals.org/lookup/suppl/doi:10.1161/STR.0000000000000086/-/DC1.The American Heart Association requests that this document be cited as follows: Demaerschalk BM, Kleindorfer DO, Adeoye OM, Demchuk AM, Fugate JE, Grotta JC, Khalessi AA, Levy EI, Palesch YY, Prabhakaran S, Saposnik G, Saver JL, Smith EE; on behalf of the American Heart Association Stroke Council and Council on Epidemiology and Prevention. Scientific rational...

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“…[2] Preferential flow changes in right sided vessels in Stanford type A dissection is responsible for predominant left hemiparesis in these patients with aortic dissection. [3,4] According to Iguchi et al, [3] warning signs for acute stroke with AAD are asymmetrical pulses, hypotension and/or left hemiparesis. Hypotension was the only warning sign in our patient.…”

Section: Aortic Dissection Presenting As Acute Stroke: Careful Selectmentioning

confidence: 99%

Aortic dissection presenting as acute stroke: Careful selection of patients for intravenous thrombolysis

et al. 2013

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Hyper-acute Stroke Patients Associated with Aortic Dissection

Abstract: Backgrounds and propose Intravenous thrombolysis using tissue plasminogen activator (tPA)

Cited by 50 publications

References 15 publications

Frequency and Detection of Stanford Type A Aortic Dissection in Hyperacute Stroke Management

Frequency and Detection of Stanford Type A Aortic Dissection in Hyperacute Stroke Management

Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

Aortic dissection presenting as acute stroke: Careful selection of patients for intravenous thrombolysis

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