Sorkin Grant C, Dumont Travis M, Mokin Maxim, Eller Jorge L, Natarajan Sabareesh K, Levy Elad I, Siddiqui Adnan H
Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo Neurosurgery, State University of New York, Buffalo, NY, USA ; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, NY, USA.
Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo Neurosurgery, State University of New York, Buffalo, NY, USA ; Toshiba Stroke and Vascular Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA ; Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, NY, USA ; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, NY, USA.
J Vasc Interv Neurol. 2015 Jul;8(3):50-5.
A 57-year-old woman with National Institutes of Health Stroke Scale (NIHSS) score of 26 was found to have an acute left carotid occlusion with tandem left M1 thrombus within 1.5 hours of symptom onset. After no neurologic improvement following standard-dose intravenous (IV) recombinant tissue plasminogen activator (rtPA), emergent neuroendovascular revascularization with carotid stenting and intracranial thrombectomy were performed under conscious sedation. Thrombolysis in myocardial infarction (TIMI)-3 flow restoration and symptom resolution were achieved postprocedure; however, complete carotid stent thrombosis was noted on final angiographic runs (25 minutes later), correlating with neurologic decline. Rapid administration of an intraarterial (IA) bolus dose of eptifibatide resulted in TIMI-3 flow restoration, with neurologic improvement. The patient was discharged three days postrevascularization on dual antiplatelet therapy with an NIHSS score of 1. Intraarterial (IA) eptifibatide can be an effective option for acute stent occlusion during emergent neuroendovascular revascularization after IV rtPA administration.
CLEARCombined approach to lysis utilizing eptifibatide and RtPACTcomputed tomographicFrFrenchGPglycoproteinIAintraarterialICAinternal carotid arteryIVintravenousMCAmiddle cerebral arteryNIHSSNational Institutes of Health Stroke ScalertPArecombinant tissue plasminogen activatorTIMIthrombolysis in myocardial infarction.
一名57岁女性，美国国立卫生研究院卒中量表（NIHSS）评分为26分，在症状发作后1.5小时内被发现急性左颈动脉闭塞并伴有串联的左M1段血栓形成。在标准剂量静脉注射重组组织型纤溶酶原激活剂（rtPA）后神经功能无改善，遂在清醒镇静下进行了紧急神经血管重建术，包括颈动脉支架置入术和颅内血栓切除术。术后实现了心肌梗死溶栓（TIMI）-3级血流恢复和症状缓解；然而，在最后一次血管造影（25分钟后）时发现颈动脉支架完全血栓形成，与神经功能衰退相关。快速动脉内（IA）推注依替巴肽后实现了TIMI-3级血流恢复，神经功能改善。患者在血管重建术后三天出院，接受双重抗血小板治疗，NIHSS评分为1分。动脉内（IA）依替巴肽可作为静脉注射rtPA后紧急神经血管重建术中急性支架闭塞的有效选择。
CLEAR利用依替巴肽和rtPA的联合溶栓方法；CT计算机断层扫描；Fr法国；GP糖蛋白；IA动脉内；ICA颈内动脉；IV静脉内；MCA大脑中动脉；NIHSS美国国立卫生研究院卒中量表；rtPA重组组织型纤溶酶原激活剂；TIMI心肌梗死溶栓
