Lekoubou Alain, Philippeau Frédéric, Derex Laurent, Olaru Angel, Gouttard Michel, Vieillart Anne, Kengne Andre Pascal
Neurol Res. 2014 Jul;36(7):687-94. doi: 10.1179/1743132813Y.0000000302. Epub 2013 Dec 19.
Post-intravenous recombinant tissue plasminogen activator (r-tPA) orolingual angioedema (PIROLA), including the life-threatening form, is an underappreciated complication of ischaemic stroke treatment.
We present an audit report and a systematic review of published observational studies on PIROLA occurrence in acute ischaemic stroke patients.
Clinical files of patients treated in the stroke unit of Bourg-en-Bresse General Hospital (France) from January 2010 to December 2012 were reviewed, and MEDLINE (inception to May 2013) were searched and bibliographies/citations of retrieved articles examined for evidence of PIROLA.
Of the 129 acute ischaemic stroke patients treated at Bourg-en-Bresse between 2010 and 2012, four patients, all receiving angiotensin converting enzyme inhibitor (ACEI), developed a PIROLA (cumulative incidence rate: 32‰). The complication started within an hour of receiving r-tPA and integrally resolved within 3-24 hours, with antihistamines/steroid treatment in two patients. The systematic review identified 27 studies, totalising with ours, over 9050 acute ischaemic stroke patients from 12 countries, among whom 100 (cumulative incidence rate: 17‰; 95% confidence intervals: 8-26), developed a PIROLA within 6-240 minutes of receiving r-tPA, 0-100% of them occurring among patients on ACEI. The complication was contralateral to the stroke location in 47% cases, ipsilateral in 14%, and bilateral in 39%; and resolved within 24 hours with treatment in 90%. No related death was recorded.
About 17‰ acute ischaemic stroke patients receiving r-tPA develop PIROLA, occurring essentially among those on concomitant ACEI. PIROLA occurrence should be actively monitored, particularly within the first few hours as some may require urgent lifesaving procedures.
静脉注射重组组织型纤溶酶原激活剂（r-tPA）后发生的口咽血管性水肿（PIROLA），包括危及生命的类型，是缺血性中风治疗中一种未得到充分认识的并发症。
我们提供一份审计报告，并对已发表的关于急性缺血性中风患者中PIROLA发生率的观察性研究进行系统评价。
回顾了2010年1月至2012年12月在法国布雷斯地区布尔格综合医院卒中单元接受治疗的患者的临床病历，并检索了MEDLINE（创刊至2013年5月），检查检索文章的参考文献/引文以寻找PIROLA的证据。
在2010年至2012年期间在布雷斯地区布尔格接受治疗的129例急性缺血性中风患者中，有4例患者均接受血管紧张素转换酶抑制剂（ACEI），发生了PIROLA（累积发生率：32‰）。并发症在接受r-tPA后1小时内开始，并在3 - 24小时内完全消退，2例患者接受了抗组胺药/类固醇治疗。系统评价确定了27项研究，与我们的研究总计，来自12个国家的9050多名急性缺血性中风患者中，有100例（累积发生率：17‰；95%置信区间：8 - 26）在接受r-tPA后6 - 240分钟内发生了PIROLA，其中0 - 100%发生在服用ACEI的患者中。47%的病例并发症与中风部位对侧，14%同侧，39%双侧；90%经治疗后在24小时内消退。未记录相关死亡病例。
约17‰接受r-tPA的急性缺血性中风患者发生PIROLA，主要发生在同时服用ACEI的患者中。应积极监测PIROLA的发生，尤其是在最初几个小时内，因为有些患者可能需要紧急救命措施。
