Subsequent Subarachnoid Hemorrhage from Clinically Unrelated Vertebral Artery Dissection after Thrombolytic Therapy

Bae, Min-Jeong; Ha, Sam Yeol

doi:10.5469/neuroint.2021.00458

Cited by 3 publications

(1 citation statement)

References 19 publications

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“…Ultra‐early arterial thrombolysis and mechanical embolization are considered to be the most effective treatments for AIS; however, patients often miss treatment opportunities owing to missed treatment windows or comorbidities (Jolugbo & Ariens, 2021; Menon et al, 2018; Moussaddy et al, 2018). At the same time, the safety of thrombolysis and mechanical thrombolysis treatment is also problematic (Bae & Ha, 2022; Balami et al, 2018); therefore, in clinical practice, the use of anticoagulants, fibrin modulators and antiplatelet agents alone or in combination with neuroprotective drugs is still the main therapy used for the prevention and treatment of different types of secondary brain injury (Wu et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

A pharmacokinetics interaction study of antiplatelet agents aspirin and clopidogrel combined with dl‐3‐n‐butylphthalide in rats by liquid chromatography–tandem mass spectrometry

Tan

et al. 2023

Biomedical Chromatography

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A sensitive and specific high‐performance liquid chromatography–tandem mass spectrometry method has been developed to determine the pharmacokinetic interactions of the antiplatelet agents aspirin and clopidogrel combined with dl‐3‐n‐butylphthalide. For the determination of aspirin metabolite salicylic acid, clopidogrel inactive metabolite SR26334 and NBP prototype drug in rat plasma, plasma samples were prepared by precipitation of proteins using methanol containing 0.1% formic acid, followed by centrifugation. Chromatography was performed on a C18 column, eluting with a gradient of acetonitrile (with 0.1% formic acid)–water (with 0.1% formic acid). The detection adopted electrospray ion source and positive ion multiple reaction monitoring modes. The linear detection response range of salicylic acid is 80–80,000 ng/ml, and the linear detection response range of SR26334 and dl‐3‐n‐butylphthalide is 10–10,000 ng/ml. Our study revealed that dl‐3‐n‐butylphthalide affected the pharmacokinetics of aspirin and clopidogrel when administered to rats.

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Section: Introductionmentioning

confidence: 99%

A pharmacokinetics interaction study of antiplatelet agents aspirin and clopidogrel combined with dl‐3‐n‐butylphthalide in rats by liquid chromatography–tandem mass spectrometry

Tan

et al. 2023

Biomedical Chromatography

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Intravenous Thrombolysis in Patients With Cervical Artery Dissection

Shu,

Akpokiere,

Mandel

et al. 2024

Neurology

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ObjectivesCervical artery dissection (CeAD) accounts for 25% of ischemic strokes in young adults. This study evaluated the benefits and harms of intravenous thrombolysis (IVT) in patients presenting with spontaneous CeAD and acute ischemic stroke symptoms. MethodsThis analysis used data from the retrospective STOP-CAD study and included patients with spontaneous CeAD who presented within 1 day of acute ischemic stroke symptoms. Patients were dichotomized into those who received IVT and those managed without IVT. We assessed the association between IVT and 90-day functional independence (modified Rankin Scale scores 0-2) and the incidence of symptomatic intracranial hemorrhage (ICH, defined as ICH causing new or worsening neurologic symptoms within 72 hours after CeAD diagnosis). ResultsThis study included 1,653 patients from the original STOP-CAD cohort of 4,023. The median age was 49 years, and 35.1% were women; 512 (31.0%) received IVT. IVT was associated with 90-day functional independence (adjusted odds ratio [aOR] = 1.67, 95% CI 1.23-2.28, p = 0.001), but not with symptomatic ICH (aOR = 1.52, 95% CI 0.79-2.92, p = 0.215). DiscussionIn patients with spontaneous CeAD and suspected ischemic stroke, IVT improved functional outcomes, without increasing symptomatic ICH risk. These findings support current guideline recommendations to consider thrombolysis for otherwise eligible patients with CeAD. Classification of EvidenceThis study provides Class III evidence that IVT significantly increases the probability of 90-day functional independence in patients with CeAD.

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High-resolution magnetic resonance imaging in the diagnosis and management of vertebral artery dissection: A case report

Zhang,

Duan,

Zhou

et al. 2024

World J Radiol

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BACKGROUND Vertebral artery dissection (VAD) is a rare but life-threatening condition characterized by tearing of the intimal layer of the vertebral artery, leading to stenosis, occlusion or rupture. The clinical presentation of VAD can be heterogeneous, with common symptoms including headache, dizziness and balance problems. Timely diagnosis and treatment are crucial for favorable outcomes; however, VAD is often missed due to its variable clinical presentation and lack of robust diagnostic guidelines. High-resolution magnetic resonance imaging (HRMRI) has emerged as a reliable diagnostic tool for VAD, providing detailed visualization of vessel wall abnormalities. CASE SUMMARY A young male patient presented with an acute onset of severe headache, vomiting, and seizures, followed by altered consciousness. Imaging studies revealed bilateral VAD, basilar artery thrombosis, multiple brainstem and cerebellar infarcts, and subarachnoid hemorrhage. Digital subtraction angiography (DSA) revealed vertebral artery stenosis but failed to detect the dissection, potentially because intramural thrombosis obscured the VAD. In contrast, HRMRI confirmed the diagnosis by revealing specific signs of dissection. The patient was managed conservatively with antiplatelet therapy and other supportive measures, such as blood pressure control and pain management. After 5 mo of rehabilitation, the patient showed significant improvement in swallowing and limb strength. CONCLUSION HR-MRI can provide precise evidence for the identification of VAD.

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Subsequent Subarachnoid Hemorrhage from Clinically Unrelated Vertebral Artery Dissection after Thrombolytic Therapy

Cited by 3 publications

References 19 publications

A pharmacokinetics interaction study of antiplatelet agents aspirin and clopidogrel combined with dl‐3‐n‐butylphthalide in rats by liquid chromatography–tandem mass spectrometry

A pharmacokinetics interaction study of antiplatelet agents aspirin and clopidogrel combined with dl‐3‐n‐butylphthalide in rats by liquid chromatography–tandem mass spectrometry

Intravenous Thrombolysis in Patients With Cervical Artery Dissection

High-resolution magnetic resonance imaging in the diagnosis and management of vertebral artery dissection: A case report

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