Safety of intravenous thrombolysis for acute ischemic stroke in specific conditions

Tsivgoulis, Georgios; Safouris, Apostolos; Alexandrov, Andrei V.

doi:10.1517/14740338.2015.1032242

Cited by 41 publications

(30 citation statements)

References 195 publications

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“…In particular, many of the criteria used in clinical trials may no longer be relevant given that the drug was first approved over 20 years ago [20-22]. Mounting evidence from pooled analyses, observational studies and clinical trials, some studying an extended time window of 4.5 h and practices less adherent with standard criteria, suggests that rtPA can be delivered safely to patients previously deemed ineligible [22-31]. …”

Section: Introductionmentioning

confidence: 99%

Does the Addition of Non-Approved Inclusion and Exclusion Criteria for rtPA Impact Treatment Rates? Findings in Australia, the UK, and the USA

et al. 2018

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Background: Strict criteria for recombinant tissue plasminogen activator (rtPA) eligibility are stipulated on licences for use in ischaemic stroke; however, practitioners may also add non-standard rtPA criteria. We examined eligibility criteria variation in 3 English-speaking countries including use of non-standard criteria, in relation to rtPA treatment rates. Methods: Surveys were mailed to 566 eligible hospitals in Australia (AUS), the UK, and the USA. Criteria were pre-classified as standard (approved indication and contraindications) or non-standard (approved warning or researcher “decoy”). Percentage for criterion selection was calculated/compared; linear regression was used to assess the association between use of non-standard criteria and rtPA treatment rates, and to identify factors associated with addition of non-standard criteria. Results: Response rates were 74% AUS, 65% UK, and 68% USA; mean rtPA treatment rates were 8.7% AUS, 12.7% UK, and 8.7% USA. Median percentage of non-standard inclusions was 33% (all 3 countries) and included National Institutes of Health Stroke Scale (NIHSS) scores > 4, computed tomography (CT) angiography documented occlusion, and favourable CT perfusion. Median percentage of non-standard exclusions was 25% AUS, 28% UK, and 60% USA, and included depressed consciousness, NIHSS > 25, and use of antihypertensive infusions. No AUS or UK sites selected 100% of standard exclusions. Conclusions: Non-standard criteria for rtPA eligibility were evident in all three countries and could, in part, explain comparably low use of rtPA. Differences in the use of standard criteria may signify practitioner intolerance for those derived from original efficacy studies that are no longer relevant.

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Section: Introductionmentioning

confidence: 99%

Does the Addition of Non-Approved Inclusion and Exclusion Criteria for rtPA Impact Treatment Rates? Findings in Australia, the UK, and the USA

et al. 2018

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“…30 In cases with intracranial extension, a high rate of associated subarachnoid hemorrhage has been observed, making dual-antiplatelet therapy a better choice for our patient over intravenous fibrinolytics or anticoagulation. 9,42 In critical cases, endovascular intervention is highly favored over open surgical repair due to its exceedingly lower perioperative stroke risk (0.02% vs 10%) and mortality rate (nearly 0% vs 2%). 33,45 Our patient's critical stenoses made her a candidate for acute endovascular intervention especially since she, a young, active woman, was experiencing recurring dominant-hemisphere symptoms at rest (despite collateral circulation), putting her at high risk for future hypoperfusion and possible stroke.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous bilateral internal carotid and vertebral artery dissections with dominant-hemisphere circulation maintained by external carotid artery–ophthalmic artery anastomoses

Golub

Hu²,

Dogra³

et al. 2019

Neurosurgical Focus

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Spontaneous cervical artery dissection (sCAD) is a major cause of stroke in young adults. Multiple sCAD is a rarer, more poorly understood presentation of sCAD that has been increasingly attributed to cervical trauma such as spinal manipulation or genetic polymorphisms in extracellular matrix components. The authors present the case of a 49-year-old, otherwise healthy woman, who over the course of 2 weeks developed progressive, hemodynamically significant, bilateral internal carotid artery and vertebral artery dissections. Collateral response involved extensive external carotid artery–internal carotid artery anastomoses via the ophthalmic artery, which were instrumental in maintaining perfusion because circle of Willis and leptomeningeal anastomotic responses were hampered by the dissection burden in the corresponding collateral vessels. Endovascular intervention by placement of Pipeline embolization devices and Atlas stents in bilateral internal carotid arteries was successfully performed. No syndromic or systemic etiology was discovered during a thorough workup.

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“…Intracranial hemorrhage and recurrent infarction in patients with carotid dissection were found to occur approximately as frequently as in patients without carotid dissection [ 3 ]. The Safe Implementation of Thrombolysis in Stroke-Monitoring Study also reported that the occurrence of adverse effects was similar with or without intravenous thrombolysis in patients with cerebral infarction caused by carotid or vertebral dissection [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…In previous studies, it was reported that thrombolysis could cause hemopericardium or cardiac tamponade by aortic rupture [ 5 ]. Thrombolysis could reduce the patient’s possibility of survival by leading to the postponement of an emergency operation to treat a Stanford Type A aortic dissection [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Delayed Surgery for Aortic Dissection after Intravenous Thrombolysis in Acute Ischemic Stroke

Choi

Yoon

Park

et al. 2016

Korean J Thorac Cardiovasc Surg

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We report a case of aortic dissection masquerading as acute ischemic stroke followed by intravenous thrombolysis. A 59-year-old man presented with dizziness. After examination, the patient had a seizure with bilateral Babinski signs. Soon after identifying multiple acute infarctions in both hemispheres on diffusion-weighted brain magnetic resonance (MR) imaging, tissue plasminogen activator (t-PA) was administered. Both common carotid arteries were invisible on MR angiography, and subsequent chest computed tomography revealed an aortic dissection. The emergency operation was delayed for 13 hours due to t-PA administration. The patient died of massive bleeding.

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Safety of intravenous thrombolysis for acute ischemic stroke in specific conditions

Cited by 41 publications

References 195 publications

Does the Addition of Non-Approved Inclusion and Exclusion Criteria for rtPA Impact Treatment Rates? Findings in Australia, the UK, and the USA

Does the Addition of Non-Approved Inclusion and Exclusion Criteria for rtPA Impact Treatment Rates? Findings in Australia, the UK, and the USA

Spontaneous bilateral internal carotid and vertebral artery dissections with dominant-hemisphere circulation maintained by external carotid artery–ophthalmic artery anastomoses

Delayed Surgery for Aortic Dissection after Intravenous Thrombolysis in Acute Ischemic Stroke

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