Early Recurrent Ischemic Stroke Complicating Intravenous Thrombolysis for Stroke Incidence and Association With Atrial Fibrillation
Early Recurrent Ischemic Stroke Complicating Intravenous Thrombolysis for Stroke Incidence and Association With Atrial Fibrillation
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DOI：
10.1161/strokeaha.109.569459
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发表时间：
2010-09-01
期刊：
影响因子：
8.3
通讯作者：
Muir, Keith W.
中科院分区：
文献类型：
--
作者：
Awadh, Mostafa;MacDougall, Niall;Muir, Keith W.
背景和目的：静脉注射重组组织型纤溶酶原激活剂（IV rt-PA）治疗后早期神经功能恶化的机制包括症状性脑出血（SICH）和早期复发性缺血性卒中。我们观察了一些急性恶化的情况下，由于反复缺血events. Methods，我们进行了一个单中心，回顾性分析，连续急性中风患者治疗IV rt-PA在2006年1月至2008年12月之间，以确定早期神经功能恶化（>= 4点下降的国立卫生研究院卒中量表在72小时内）的发病率及其机制。恶化归因于SICH时，与PH 1或PH 2出血的postdependence计算机断层扫描，复发性缺血性卒中时，有临床和放射学证据的一个新的领域梗死或新的血管闭塞，否则演变的事件stroke.Results-Of 228连续IV rt-PA治疗的患者，34（15%）发展早期神经功能恶化，18例（8%）继发于卒中事件，10例（4.4%）由于SICH，6例（2.6%）由于早期复发性缺血事件，与房颤显著相关（6例患者中有5例; 4例阵发性，1例永久性）。在4例患者中，在IV rt-PA输注期间或输注后不久突然出现临床恶化，2例患者在3天后出现恶化。所有动物均于2天至2周后死亡。无房颤的1例患者在IV rt-PA输注期间出现对侧复发性大脑中动脉卒中，经颅多普勒检测到多个高信号栓子。早期复发性缺血性卒中占5 12（42%）例早期神经功能恶化的患者atrialfibrillation.Conclusion-In此单中心系列，早期复发性缺血性卒中后IV rt-PA的发病率为2.6%，并与以前的房颤。（中风。2010; 41：1990-1995.）
Background and Purpose-Mechanisms of early neurologic deterioration after treatment with intravenous, recombinant, tissue-type plasminogen activator (IV rt-PA) include symptomatic intracerebral hemorrhage (SICH) and early recurrent ischemic stroke. We observed a number of cases of acute deterioration due to recurrent ischemic events.Methods-We undertook a single-center, retrospective analysis of consecutive acute stroke patients treated with IV rt-PA between January 2006 and December 2008 to define the incidence of early neurologic deterioration (>= 4-point drop on the National Institutes of Health Stroke Scale within 72 hours) and its mechanism. Deterioration was attributed to SICH when associated with a PH1 or PH2 hemorrhage on postdeterioration computed tomography scans, to recurrent ischemic stroke when there was clinical and radiologic evidence of a new territorial infarction or new vessel occlusion, and otherwise to evolution of the incident stroke.Results-Of 228 consecutive IV rt-PA-treated patients, 34 (15%) developed early neurologic deterioration, 18 (8%) secondary to incident strokes 10 (4.4%) due to SICH, and 6 (2.6%) due to early recurrent ischemic events, which were significantly associated with atrial fibrillation (present in 5 of 6 patients; 4 paroxysmal, 1 permanent). In 4 patients, sudden clinical deterioration developed during or shortly after IV rt-PA infusion, and in 2, deterioration developed 3 days later. All died 2 days to 2 weeks later. The single case without atrial fibrillation had a recurrent, contralateral, middle cerebral artery stroke during IV rt-PA infusion and multiple high-signal emboli detected by transcranial Doppler. Early recurrent ischemic stroke accounted for 5 of 12 (42%) cases of early neurologic deterioration in patients with atrial fibrillation.Conclusion-In this single-center series, the incidence of early recurrent ischemic stroke after IV rt-PA was 2.6% and was associated with previous atrial fibrillation. (Stroke. 2010; 41:1990-1995.)