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颅内动脉夹层所致急性缺血性脑卒中的静脉溶栓治疗:单中心病例系列及文献复习。

Intravenous thrombolysis in acute ischemic stroke due to intracranial artery dissection: a single-center case series and a review of literature.

机构信息

Stroke Center, Neurology Service, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.

Department of Neurology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal.

出版信息

J Thromb Thrombolysis. 2019 Nov;48(4):679-684. doi: 10.1007/s11239-019-01918-6.

Abstract

Efficacy and safety of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) due to intracranial artery dissection (IAD) are currently not established. We aimed to present a single-center experience on IAD-related AIS treated by IVT. We selected all consecutive patients with IAD-related AIS treated by IVT from a prospectively constructed single-center acute stroke registry from 2003 to 2017. We reviewed demographical, clinical and neuroimaging data and recorded hemorrhagic complications, mortality within 7 days and modified Rankin Scale at 3-months. Out of 181 AISs related to cervicocephalic dissections, 10 (5.5%) were due to IAD and five of these patients received IVT. Among these five patients, median age was 62 years; hypertension and dyslipidemia were the most frequent vascular risk factors. IAD locations were distal internal carotid artery, middle cerebral artery (M1), anterior cerebral artery (A2), and, in two cases, the basilar artery. All anterior circulation IADs were occlusive or subocclusive, while the two basilar artery IADs caused arterial stenosis. After IVT, there were no subarachnoid or symptomatic intracranial hemorrhages. One patient had an asymptomatic hemorrhagic infarct type 1. Two patients died within 7 days from ischemic mass effect. The other three patients had favorable clinical outcomes at 3-months. In this small single-center case series of IAD-related AIS, thrombolysis seemed relatively safe. However, IVT efficacy and the likelihood of arterial recanalization are still uncertain in this context. Further studies are needed to assess the safety and efficacy of IVT in these patients.

摘要

静脉溶栓(IVT)治疗颅内动脉夹层(IAD)所致急性缺血性脑卒中(AIS)的疗效和安全性目前尚未确定。我们旨在介绍单中心 IAD 相关性 AIS 患者接受 IVT 治疗的经验。我们从 2003 年至 2017 年前瞻性构建的单中心急性脑卒中登记处中选择了所有接受 IVT 治疗的 IAD 相关性 AIS 连续患者。我们回顾了人口统计学、临床和神经影像学数据,并记录了出血性并发症、7 天内死亡率和 3 个月时改良 Rankin 量表评分。在 181 例与头颈部夹层相关的 AIS 中,10 例(5.5%)为 IAD,其中 5 例患者接受了 IVT。在这 5 例患者中,中位年龄为 62 岁;高血压和血脂异常是最常见的血管危险因素。IAD 部位为颈内动脉远端、大脑中动脉(M1)、大脑前动脉(A2),其中 2 例为基底动脉。所有前循环 IAD 均为闭塞或次闭塞性,而 2 例基底动脉 IAD 导致动脉狭窄。IVT 后,无蛛网膜下腔出血或症状性颅内出血。1 例患者出现无症状性出血性梗死 1 型。2 例患者在缺血性肿块效应 7 天内死亡。其余 3 例患者在 3 个月时临床预后良好。在这项小型单中心 IAD 相关性 AIS 病例系列研究中,溶栓似乎相对安全。然而,在这种情况下,IVT 的疗效和动脉再通的可能性仍不确定。需要进一步的研究来评估这些患者接受 IVT 的安全性和疗效。

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