Successful Thrombolysis despite Having an Incidental Unruptured Cerebral Aneurysm

Gala, Diana; Almeida, André; Monteiro, Nadine; Nunes, Ana Paiva; Ferreira, Patrı́cia; Mendonça, Nuno; Amaral‐Silva, Alexandre; Alcântara, João Otávio Scarano

doi:10.1155/2014/323049

Cited by 5 publications

(5 citation statements)

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“…But the treatment opportunity of interventional embolization is controversial. It has been pointed out that the presence of blood clot and cerebral tissue swelling could affect the expose of aneurysm of some patients with aneurysm rupture, which could increase surgical risks and difficulties, and that symptomatic treatment such as reducing intracranial pressure and controlling disease condition before surgery and performing surgery after peak stage of occurrence of cerebral angiospasm are helpful to patients 16. Performing surgery as soon as possible is also advocated to avoid the deterioration of disease condition 17.…”

Section: Discussionmentioning

confidence: 99%

Early interventional embolization in the treatment of cerebral aneurysm rupture

Jiang

Xie

2018

Pak J Med Sci

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Objective:To analyze the clinical effectiveness and safety of early interventional embolization in the treatment of ruptured cerebral aneurysm.Methods:Eighty-eight patients with cerebral aneurysm rupture who were admitted to the hospital between February 2015 and October 2016 were selected as the research subjects and were randomly divided into a control group (N=44) and an observation group (N=44) using random number table. Patients in the control group were given interventional embolization three days after admission, while patients in the observation group were given interventional embolization within three days after admission. The complete, sub complete and incomplete embolization rates were compared between the two groups. The prognosis of the patients was evaluated using modified Rankin scale and modified Barthel index. The incidences of complications were recorded.Results:The complete, sub-complete and incomplete embolization rates of the observation group and control group were significantly different (P<0.05). The modified Rankin score of the observation group was remarkably lower than that of the control group, and the modified Barthel index of the observation group was remarkably higher than that of the control group; the differences had statistical significance (P<0.05). The incidence of complications of the observation group was lower than that of the control group, and the difference had statistical significance (P<0.05).Conclusion:Early interventional embolization has satisfactory effect in the treatment of cerebral aneurysm rupture and effectively improve prognosis; hence it is worth promotion in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Early interventional embolization in the treatment of cerebral aneurysm rupture

Jiang

Xie

2018

Pak J Med Sci

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“…Intravenous t-PA was recognized as the approved thrombolytic agent for acute ischemic stroke that can improve patients' outcome and resolve their neurological deficits. The main reason for the difficulty of stroke treatment is the narrow time window, which leads to a small proportion of eligible patients to be treated with t-PA (16). The first clinical application of t-PA, with the aim of dose verification, mechanism of action, and safety profile, in stroke thrombolysis, began in early 1990s.…”

Section: Tissue Plasminogen Activator In Stroke: Dosage and Time Windowmentioning

confidence: 99%

“…The budget impact analysis, based on stroke incidence rates and the impact of thrombolysis on society's health, showed that thrombolysis improve society's health, although the quality of life may have a stronger association with age, sex, level of education and post-stroke duration (34)(35)(36). The most serious complication of rt-PA thrombolytic therapy is intracranial hemorrhage (ICH) (16). Based on NINDS trials, ICH could be categorized in two groups: 1) symptomatic ICH, documented with computed tomography (CT) and associated with clinical deterioration; 2) ICH with CT finding and no clinical deterioration (9).…”

Section: Profits and Possible Side Effects Of Tissue Plasminogen Actimentioning

confidence: 99%

Tissue Plasminogen Activator: A Literature Review

et al. 2016

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The production of thrombolytic agents started in 1930s and thrombolytic therapy for stroke began in 1958, on a case by case basis, and, in 1963, a small trial performed. Evidence Acquisition: Intravenous tissue plasminogen activator (t-PA) was recognized and approved as the thrombolytic agent for acute ischemic stroke that can improve patients' outcome and resolve their neurological deficits. The main reason for the difficulty of stroke treatment is the narrow time window, which leads to a small proportion of eligible patients to be treated with t-PA. The cost-effectiveness and feasibility of intravenous t-PA for treatment of acute stroke in 3-4.5 hour time window, after symptom onset, have been confirmed in previous studies. Results: Data about thrombolytic therapy, at the national level, are scarce in Asia and developing countries, compared to developed world. Thrombolytic therapy using t-PA is used in few low-income countries, including Iran. According to estimations of Iranian stroke patients, eligible for thrombolysis therapy, only 30% of Iranian stroke patients received t-PA. Conclusions: The high cost of t-PA and lack of appropriate infrastructure are the main barriers for thrombolytic therapy, in developing countries like Iran. On the other hand, most stroke units and centers, which have the infrastructure to deliver thrombolysis, are predominantly available only in large urban areas.

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“…Some case reports have discussed the safety of applying r-tPA to patients with unruptured intracranial aneurysms [ 8 , 9 ]. In particular, some have demonstrated the bleeding risk of administering r-tPA in patients with unruptured intracranial aneurysm.…”

Section: Introductionmentioning

confidence: 99%

The risk of intravenous thrombolysis-induced intracranial hemorrhage in Taiwanese patients with unruptured intracranial aneurysm

et al. 2017

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BackgroundThe presence of an intracranial aneurysm is contraindicated to recombinant tissue plasminogen activator (r-tPA) treatment for acute ischemic stroke. However, it is difficult to exclude asymptomatic intracranial aneurysms by using conventional, noncontrast head computed tomography (CT), which is the only neuroimaging suggested before r-tPA. Recent case reports and series have shown that administering r-tPA to patients with a pre-existing aneurysm does not increase the bleeding risk. However, Asians are known to have a relatively higher bleeding risk, and little evidence is available regarding the risk of using r-tPA on Asian patients with intracranial aneurysms.MethodsMedical records from the Shuang Ho hospital stroke registration between July 2010 and December 2014 were retrospectively reviewed, and 144 patients received r-tPA. Unruptured intracranial aneurysms were detected using CT, or magnetic resonance or conventional angiography after r-tPA. The primary and secondary outcomes were the difference in overall intracranial hemorrhage (ICH) and symptomatic ICH after r-tPA. The differences were analyzed using Fisher’s exact or Mann–Whitney U tests, and p < 0.05 was defined as the statistical significance.ResultsA total of 144 patients were reviewed, and incidental unruptured intracranial aneurysms were found in 11 of them (7.6%). No significant difference was observed in baseline demographic data between the aneurysm and nonaneurysm groups. Among patients with an unruptured aneurysm, two had giant aneurysms (7.7 and 7.4 mm, respectively). The bleeding risk was not significant different between aneurysm group (2 out of 11, 18%) with nonaneurysm group (7 out of 133, 5.3%) (p = 0.14). None of the patients with an unruptured aneurysm had symptomatic ICH, whereas one patient without an aneurysm exhibited symptomatic ICH.ConclusionsThe presence of an unruptured intracranial aneurysm did not significantly increase the risk of overall and symptomatic ICH in Taiwanese patients after they received r-tPA.

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Successful Thrombolysis despite Having an Incidental Unruptured Cerebral Aneurysm

Cited by 5 publications

References 13 publications

Early interventional embolization in the treatment of cerebral aneurysm rupture

Early interventional embolization in the treatment of cerebral aneurysm rupture

Tissue Plasminogen Activator: A Literature Review

The risk of intravenous thrombolysis-induced intracranial hemorrhage in Taiwanese patients with unruptured intracranial aneurysm

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