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急性卒中使用组织型纤溶酶原激活剂(t-PA)治疗后发生心肌梗死。

Myocardial infarction following t-PA for acute stroke.

作者信息

Mehdiratta M, Murphy C, Al-Harthi A, Teal P A

机构信息

Beth Israel Deaconess Medical Center, Stroke Division, Harvard Medical School, Boston, MA 02215, USA.

出版信息

Can J Neurol Sci. 2007 Nov;34(4):417-20. doi: 10.1017/s0317167100007289.

Abstract

BACKGROUND AND PURPOSE

Complications of intravenous (IV) thrombolysis with tissue plasminogen activator (t-PA) for acute stroke are commonly related to hemorrhage, anaphylaxis, or arterial re-occlusion. Embolic complications of t-PA are beginning to be recognized with increased use of t-PA for acute ischemic stroke. We hypothesize that disruption of intra-cardiac thrombus may result in myocardial infarction (MI) after use of t-PA for acute ischemic stroke.

SUMMARY OF CASES

We describe three cases of acute MI immediately following IV t-PA infusion for acute stroke. In patient #1 apical thrombus was visualized on cardiac echocardiogram accounting for the MI after t-PA for acute stroke. Patient #2 had fresh thrombus seen on cardiac catherization after use of t-PA for acute stroke. Patient #3 developed a significant troponin rise 15 hours after the t-PA for stroke infusion with an echocardiogram revealing new wall motion abnormalities. Patient # 1 and #2 died secondary to multi-organ failure.

DISCUSSION

Acute MI immediately following t-PA treatment for stroke is a rare but serious complication. The disruption of intra-cardiac thrombus and subsequent embolization to the coronary arteries may be an important mechanism in the development of MI after t-PA treatment for acute ischemic stroke.

摘要

背景与目的

组织型纤溶酶原激活剂(t-PA)静脉溶栓治疗急性卒中的并发症通常与出血、过敏反应或动脉再闭塞有关。随着t-PA在急性缺血性卒中治疗中的应用增加,t-PA的栓塞并发症开始受到关注。我们推测,急性缺血性卒中使用t-PA后,心内血栓的破裂可能导致心肌梗死(MI)。

病例总结

我们描述了3例急性卒中静脉输注t-PA后立即发生急性MI的病例。病例1在心脏超声心动图上可见心尖部血栓,这是急性卒中使用t-PA后发生MI的原因。病例2在急性卒中使用t-PA后,心脏导管检查发现新鲜血栓。病例3在输注t-PA治疗卒中15小时后肌钙蛋白显著升高,超声心动图显示有新的室壁运动异常。病例1和病例2死于多器官功能衰竭。

讨论

卒中t-PA治疗后立即发生急性MI是一种罕见但严重的并发症。心内血栓破裂及随后栓塞至冠状动脉可能是急性缺血性卒中t-PA治疗后发生MI的重要机制。

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