Successful intravenous thrombolysis for acute ischemic stroke caused by aortic dissection with severe hypofibrinogenemia: a case report and literature review

Huang, Xuming; Zui, Fei-Qi

doi:10.1080/00207454.2020.1858823

Cited by 3 publications

(4 citation statements)

References 16 publications

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“…4 AIS secondary to AD can often be inadvertently given IVT and cerebral angiography because the symptoms of these patients were latent-lack of chest pain and other typical manifestations -or obscured by unconsciousness or dysphasia. 16 Although IVT might be efficacious in the minority of such patients with a thromboembolic mechanism 4 and there have been many successful reports, [3][4][5][17][18][19] IVT is still contraindicated for AIS secondary to AD. 2,14 The hydraulic stress during cerebral angiography, especially aortic arch angiography, may aggravate the extent of the intimal tear.…”

Section: Discussion and Post Hoc Analysismentioning

confidence: 99%

“…1,2 However, it has been reported that IVT with alteplase is safe and beneficial for some of these patients. [3][4][5] Cerebral angiography is necessary before performing EVT but is contraindicated for Stanford type A AD, even if it is not specified in the current guidelines. In China, not all hospitals can conduct AD screening for hyperacute ischemic stroke in a timely manner.…”

mentioning

confidence: 99%

“…Current guidelines specifically state that AIS secondary to AD is a contraindication for IVT 1,2. However, it has been reported that IVT with alteplase is safe and beneficial for some of these patients 3–5. Cerebral angiography is necessary before performing EVT but is contraindicated for Stanford type A AD, even if it is not specified in the current guidelines.…”

mentioning

confidence: 99%

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Hidden Telltale Signs in Hyperacute Ischemic Stroke Caused by Aortic Dissection

Ning-lin

et al. 2022

The Neurologist

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Introduction: Rapid identification of hidden telltale signs in hyperacute ischemic stroke caused by aortic dissection (AD) is challenging, mainly owing to the narrow time window for bridging therapy. Case Report: A 63-year-old man was referred for sudden right-side weakness accompanied by a decreased level of consciousness for almost 1 hour and 37 minutes. He had a history of hypertension. His skin was clammy, and on physical examination, there was involuntary chest thumping in the left upper limb. Hyperacute cerebral infarction was considered after no bleeding was observed on emergency head computed tomography, and intravenous thrombolysis with alteplase was administered immediately after. The patient was then taken to the catheter room, ready for endovascular thrombectomy. Stanford type A AD was found by cerebral angiography before endovascular thrombectomy. The infusion of alteplase was stopped immediately during cerebral angiography, but the patient’s blood pressure, heart rate, and blood oxygen were still declining progressively, and the degree of consciousness disturbance deepened. The patient died after the combined but failed rescue attempts of multiple departments. Conclusion: Hyperacute ischemic stroke caused by AD often hides some telltale signs. Clinicians should master basic clinical skills to exclude AD by looking for these telltale signs hidden in hyperacute ischemic stroke to avoid the fatal consequences of intravenous thrombolysis and/or cerebral angiography within the narrow window of time.

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Section: Discussion and Post Hoc Analysismentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Hidden Telltale Signs in Hyperacute Ischemic Stroke Caused by Aortic Dissection

Ning-lin

et al. 2022

The Neurologist

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“…IVT can also lessen the neurological symptoms of AD-related ischemic stroke, although strict monitoring is required to prevent aneurysm rupture. Following IVT, fibrinogen levels should also be routinely checked for the early identification of hypofibrinogenemia [8].…”

Section: Related Workmentioning

confidence: 99%

The recognition of severe thoracic aortic dissection using conventional chest radiography in conjunction with a whale optimized bilateral residual convolutional neural network

Naveen¹,

Bishnoi²,

Malathi³

2023

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A life-threatening condition called severe thoracic aortic dissection (STAD) is brought on by blood leakage from the aorta's injured inner layer, which separates the intimal and adventitial layers. It is difficult to make a diagnosis for this disease. Chest x-rays are frequently used for initial screening or diagnosis, however their diagnostic accuracy is not great. Deep learning (DL) has recently been effectively used for a variety of medical image processing tasks. By using DL techniques, we try to enhance the accuracy of the diagnosis of STAD made on the basis of chest x-rays in this work. The significant thoracic aortic dissection was detected using the Whale optimized bilateral residual convolutional neural network (WO-BRCNN). The WO-BRCNN accuracy was found to be 99.21%, with precision at 94.93%, recall at 97.89%, F1-score at 95.71% and specificity at 93.42%. To increase diagnostic accuracy using aorta segmentation, further study is required.

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Alteplase

2022

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Successful intravenous thrombolysis for acute ischemic stroke caused by aortic dissection with severe hypofibrinogenemia: a case report and literature review

Cited by 3 publications

References 16 publications

Hidden Telltale Signs in Hyperacute Ischemic Stroke Caused by Aortic Dissection

Hidden Telltale Signs in Hyperacute Ischemic Stroke Caused by Aortic Dissection

The recognition of severe thoracic aortic dissection using conventional chest radiography in conjunction with a whale optimized bilateral residual convolutional neural network

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