Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel and Kiel University, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel and Kiel University, Kiel, Germany.
J Neurol. 2023 Sep;270(9):4354-4359. doi: 10.1007/s00415-023-11765-4. Epub 2023 May 22.
Intravenous thrombolysis (IVT) and endovascular mechanical thrombectomy therapy (MT) are well established in the treatment of acute ischemic stroke. It is currently unclear whether these treatments can be applied in patients with previous deep brain stimulation (DBS) surgery and how long the interval to the DBS operation should be.
Four patients with ischemic stroke and IVT or MT were included in this retrospective case series. Data on demographics, genesis, severity and course of the stroke and the DBS indication were extracted and evaluated. Furthermore, a literature review was conducted. Outcomes and hemorrhagic complications after IVT, MT or intra-arterial thrombolysis in patients with prior deep brain stimulation surgery and intracranial surgery were analyzed.
Four patients with acute ischaemic stroke and previous DBS surgery were treated with IVT (2 patients), MT (1) or a combined therapy of IVT and MT (1). The time interval to the previous DBS surgery was between 6 and 135 months. In these four patients, no bleeding complications occurred. The literature review revealed four publications with a total of 18 patients, who were treated with IVT, MT or intra-arterial thrombolysis. Of these 18 patients, only 1 had undergone deep brain stimulation surgery, the other 17 patients had received brain surgery for other reasons. Bleeding complications occurred in four of the 18 reported patients, but not in the DBS case. All four patients with bleeding complications were reported to have died as a result. In three of the four patients with fatal outcome, surgery was less than 90 days before the onset of stroke.
IVT and MT were tolerated by four patients with ischemic stroke more than 6 months after DBS surgery without bleeding complications.
静脉溶栓（IVT）和血管内机械血栓切除术（MT）已被广泛应用于急性缺血性脑卒中的治疗。目前尚不清楚这些治疗方法是否适用于先前接受过深部脑刺激（DBS）手术的患者，以及 DBS 手术与当前脑卒中发作之间的间隔时间应为多长。
本回顾性病例系列研究纳入了 4 例接受 IVT 或 MT 治疗的缺血性脑卒中患者。提取并评估了患者的人口统计学、发病机制、严重程度和脑卒中病程以及 DBS 适应证相关数据。此外，还进行了文献回顾。分析了先前接受过深部脑刺激手术和颅内手术的患者在接受 IVT、MT 或动脉内溶栓后的结局和出血性并发症。
4 例急性缺血性脑卒中且先前有 DBS 手术的患者接受了 IVT（2 例）、MT（1 例）或 IVT 和 MT 联合治疗（1 例）。先前 DBS 手术与本次脑卒中发作的时间间隔为 6~135 个月。在这 4 例患者中，均未发生出血性并发症。文献回顾共纳入 4 篇文献，总计 18 例患者，这些患者接受了 IVT、MT 或动脉内溶栓治疗。在这 18 例患者中，仅 1 例患者接受了深部脑刺激手术，其余 17 例患者因其他原因接受了脑部手术。18 例患者中有 4 例发生了出血性并发症，但在深部脑刺激手术患者中未发生。这 4 例发生出血性并发症的患者均报告死亡。在 4 例死亡患者中，有 3 例患者的手术时间距脑卒中发作时间不足 90 天。
在 DBS 手术后 6 个月以上，4 例缺血性脑卒中患者接受 IVT 和 MT 治疗均未发生出血性并发症。
