Failure of intracisternal tissue plasminogen activator to prevent vasospasm in certain patients with aneurysmal subarachnoid hemorrhage.
Failure of intracisternal tissue plasminogen activator to prevent vasospasm in certain patients with aneurysmal subarachnoid hemorrhage.
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脑池内组织纤溶酶原激活剂无法预防某些动脉瘤性蛛网膜下腔出血患者的血管痉挛。
DOI：
10.1227/00006123-199405000-00004
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发表时间：
1994
期刊：
影响因子：
4.8
通讯作者：
G. Koenig
中科院分区：
文献类型：
--
作者：
G. Steinberg;M. Vanefsky;M. Marks;J. Adler;G. Koenig
最近的实验和临床报告表明，重组组织纤溶酶原激活剂（tPA）在蛛网膜下腔出血72小时内脑池内给药降低了严重的血管造影和临床血管痉挛的发生率。在这份报告中，我们介绍了8例蛛网膜下腔出血患者中的4例，尽管在早期动脉瘤夹闭术后使用了脑池内tPA，但仍发生了血管造影和临床血管痉挛伴迟发性神经功能恶化。1例患者未使用tPA清除大量蛛网膜下腔出血; 1例患者侧支血流极差，一条颈段颈内动脉闭塞，另一条颈段颈内动脉狭窄80%;另外2例患者在前哨出血后7 - 12天发生蛛网膜下腔出血。3例患者最终恢复良好或优良，1例患者出现轻偏瘫。接受本方案治疗的其他4例患者未发生血管痉挛。我们的结论是，脑池内tPA可能无法防止某些患者的血管痉挛。这可能与蛛网膜下腔凝块清除不充分、预先存在的侧支供应不良或既往蛛网膜下腔出血有关。
Recent experimental and clinical reports suggest that the intracisternal administration of recombinant tissue plasminogen activator (tPA) within 72 hours of subarachnoid hemorrhage decreases the incidence of severe angiographic and clinical vasospasm. In this report, we present four of eight patients with aneurysmal subarachnoid hemorrhage who developed angiographic and clinical vasospasm with delayed neurological deterioration, despite the use of intracisternal tPA after early aneurysm clipping. One patient did not clear her massive subarachnoid hemorrhage with tPA; one patient had extremely poor collateral flow with occlusion of one cervical internal carotid artery and 80% stenosis of the other cervical internal carotid artery; the other two patients had a subarachnoid hemorrhage 7 to 12 days after their sentinel hemorrhage. Three patients ultimately made excellent or good recoveries, and one was left with hemiparesis. The four other patients treated by this protocol did not develop vasospasm. We conclude that intracisternal tPA may not prevent vasospasm in certain patients. This may relate to inadequate clearing of the subarachnoid clot, pre-existing poor collateral supply, or the occurrence of prior subarachnoid hemorrhage.
红细胞对于猫蛛网膜下腔出血引起的脑血管病的发展至关重要。
影响因子：
8.3
作者：
Duff,TA;Louie,J;Feilbach,JA;Scott,G
通讯作者：
Scott,G
高容量治疗可防止容量收缩，但不能防止蛛网膜下腔出血后出现低钠血症。
影响因子：
11.2
作者：
Diringer,MN;Wu,KC;Verbalis,JG;Hanley,DF
通讯作者：
Hanley,DF
鞘内纤溶治疗时机对灵长类蛛网膜下腔出血模型脑血管痉挛的影响。
影响因子：
4.8
作者：
Findlay,JM;Weir,BK;Kanamaru,K;Grace,M;Baughman,R
通讯作者：
Baughman,R