Objective:Discussion and analysis of the effect of the early application of Tirofiban on acute ischemic stroke(AIS)after intravenous thrombolysis with urokinase.Method:The subjects of this study are 40 patients with A...Objective:Discussion and analysis of the effect of the early application of Tirofiban on acute ischemic stroke(AIS)after intravenous thrombolysis with urokinase.Method:The subjects of this study are 40 patients with AIS admitted at the Yibin Fourth People’s Hospital,of which were computer-randomized into a control group(20 cases,with regular urokinase intravenous thrombolysis therapy)and a research group(20 cases,combined with early Tirofiban treatment)from January 2018 to December 2022.The intervention outcomes between these two groups were compared and analyzed.Result:The blood platelet-related parameters before treatment had no statistical difference between the two groups(P>0.05),but the research group was higher than that of the control group after treatment(P<0.05).The Barthel index before treatment in both groups had no statistical difference(P>0.05),but the research group was higher than that of the control group after treatment(P<0.05).Conclusion:Early Tirofiban treatment for patients with AIS after intravenous thrombolysis with urokinase could effectively regulate the blood platelet-related parameters,hence improving treatment benefits and living capacity for patients,with definite clinical benefits.展开更多
BACKGROUND Left ventricular thrombus is a rare condition,for which appropriate treatments are not extensively studied.Although it can be treated by thrombectomy,such surgery can be difficult and risky,and not every pa...BACKGROUND Left ventricular thrombus is a rare condition,for which appropriate treatments are not extensively studied.Although it can be treated by thrombectomy,such surgery can be difficult and risky,and not every patient can tolerate the surgery.CASE SUMMARY We report a case of a middle-aged man receiving veno-arterial extracorporeal membrane oxygenation(VA-ECMO)for acute myocardial infarction who developed left ventricular thrombus despite systemic anticoagulation.After systemic thrombolysis with urokinase,the left ventricular thrombus disappeared,ECMO was successfully withdrawn 9 days later,and the patient recovered and was discharged from hospital.CONCLUSION Systemic thrombolysis is a treatment option for left ventricular thrombus in addition to anticoagulation and thrombectomy.展开更多
Objective: To investigate the effects of butyphthalide + alteplase (rt-PA) intravenous thrombolysis on the diffusion-weighted imaging (DWI) characteristics, coagulation function and neurological function in patients w...Objective: To investigate the effects of butyphthalide + alteplase (rt-PA) intravenous thrombolysis on the diffusion-weighted imaging (DWI) characteristics, coagulation function and neurological function in patients with acute cerebral infarction. Methods: The patients with acute cerebral infarction who were admitted to our hospital between April 2015 and October 2018 and with the onset time 4.5 hours were selected and divided into the observation group receiving butyphthalide + rt-PA intravenous thrombolysis and the control group receiving rt-PA intravenous thrombolysis by random number table. The differences in DWI parameter apparent diffusion coefficient (ADC), coagulation function indexes and neurological function indexes were compared between the two groups. Results: At 7 and 14 days after treatment, the ADC values of both groups were significantly increased, and the ADC values of the observation group were significantly higher than those of the control group;at 7 days after treatment, the prothrombin time (PT) and activated partial thromboplastin time (APTT) levels in both groups were significantly prolonged whereas fibrinogen (FIB), D-dimer (D-D), platelet activating factor (PAF), P-selectin, von Willebrand factor (vWF), neuron-specific enolase (NSE), S100B protein (S100B), malondialdehyde (MDA) and endothelin-1 (ET-1) contents were significantly decreased, and the APTT and PT levels in the observation group were significantly shorter than those in the control group whereas FIB, D-D, PAF, P-selectin, vWF, NSE, S100B, MDA and ET-1 contents were significantly lower than those in the control group. Conclusion: Butyphthalide + rt-PA intravenous thrombolysis can improve the DWI characteristics, coagulation function and neurological function of patients with acute cerebral infarction.展开更多
BACKGROUND:Studies have demonstrated that immediate anticoagulation after thrombolysis can improve the prognosis of patients with acute cerebral infarction. However,the optimal timing and means of anticoagulation ther...BACKGROUND:Studies have demonstrated that immediate anticoagulation after thrombolysis can improve the prognosis of patients with acute cerebral infarction. However,the optimal timing and means of anticoagulation therapy remain unclear. OBJECTIVE:To observe the effects and safety of heparin treatment within 24 hours after intravenous thrombolysis for acute cerebral infarction. DESIGN:Observation experiment. SETTING:Department of Neurology,the 306 Hospital of Chinese PLA. PARTICIPANTS:Fifteen acute cerebral infarction patients complicated by moderate and severe neurologic function deficits within 6 hours after attack admitted to Department of Neurology,the 306 Hospital of Chinese PLA between January 2005 and December 2006 were recruited in this study. The involved patients,11 male and 4 female,were aged 46-79 years. They all met the diagnosis criteria for various cerebrovascular diseases formulated by the 4th National Conference for Cerebrovascular Disease(1995) and confirmed as cerebral infarction by skull CT or MRI imageology. Informed consents were obtained from the patients or their relatives. METHODS:On admission,patients received thrombolysis with urokinase. Immediately after thrombolysis,skull CT was rechecked. Intracranial hemorrhage signs were not found by skull CT. Hemorrhage was also not found in skin,mucous membrane and internal organs. Six hours later,low-dose low-intensity heparin 4-8 IU/kg per hour was intravenously administrated for anticoagulation for 7-10 days successively. MAIN OUTCOME MEASURES:Neurologic function was evaluated before,immediately 6 hours and 14 days after thrombolysis by scoring standard of clinical neurologic function deficit degree for stroke patients(1995). Activities of daily living of patients with stroke were evaluated 90 days after thrombolysis by modified Rankin Scale. RESULTS:Fifteen involved patients participated in the final analysis. ① Comparison of clinical neurologic function deficit degree of patients at different time:Neurologic function deficit score at the end of thrombolysis was significantly lower than that before thrombolysis(t =3.45,P < 0.01). Neurologic function deficit score 6 hours after thrombolysis was higher than that at the end of thrombolysis,and neurologic deficits were increased,but no significant difference was found(P > 0.05). Neurologic function deficit score 14 days after thrombolysis was significantly lower than that before thrombolysis(t =4.769,P < 0.01). ② Therapeutic effect and modified Rankin scale results:14 days after thrombolysis,4 patients were basically cured,7 significantly improved,2 improved and 2 worsened. The total improvement rate of neurologic function deficit was 86.7%. Ninety days after thrombolysis,according to modified Rankin Scale,score was 0 to 2 in 12 patients(80%),3 to 4 in 2 patients(13.3%) and 6 in 1 patient(6.7%). Complications of intracranial hemorrhage were not found in patients within 14 days after thrombolysis. CONCLUSION:Low-dose and low-intensity heparin applied within 24 hours after intravenous thrombolysis has good safety and efficacy in the treatment of acute cerebral infarction.展开更多
Objective: To explore the efficacy of mild hypothermia + intravenous thrombolysis in promoting the neural functional recovery in patients with acute cerebral infarction. Methods: A total of 176 patients with acute cer...Objective: To explore the efficacy of mild hypothermia + intravenous thrombolysis in promoting the neural functional recovery in patients with acute cerebral infarction. Methods: A total of 176 patients with acute cerebral infarction who were treated in our hospital between September 2015 and February 2017 were reviewed and divided into the routine group (n=100 cases, receiving routine intravenous thrombolysis therapy) and the mild hypothermia group (n=76, receiving mild hypothermia + intravenous thrombolysis therapy), and the treatment lasted for 1 week. The differences in serum levels of nerve injury indexes, inflammatory mediators and neurotransmitters were compared between the two groups before treatment and after 1 week of treatment. Results: Before treatment, there was no statistically significant difference in serum levels of nerve injury indexes, inflammatory mediators and neurotransmitters between the two groups. After 1 week of treatment, serum nerve injury indexes H-FABP, NT-proBNP, NSE and S100B levels of mild hypothermia group were lower than those of routine group;inflammatory mediators sICAM-1, IL-8, IL-13 and IL-18 levels were lower than those of routine group;neurotransmitter Glu level was lower than that of routine group whereas GABA level was higher than that of routine group. Conclusion: mild hypothermia + intravenous thrombolysis therapy can effectively reduce the nerve injury and systemic inflammatory response, and optimize the neurotransmitter distribution in patients with acute cerebral infarction.展开更多
Objective: To explore the effect of intravenous thrombolysis bridge stent combined with aspiration embolectomy on serological indicators in patients with intracranial macrovascular infarction. Methods: 92 patients wit...Objective: To explore the effect of intravenous thrombolysis bridge stent combined with aspiration embolectomy on serological indicators in patients with intracranial macrovascular infarction. Methods: 92 patients with intracranial macrovascular infarction who received treatment in our hospital between February 2016 and January 2018 were selected as the research subjects and divided into the control group (n=46) and the study group (n=46) by random number table method. Control group received stent embolectomy alone, and study group received intravenous thrombolysis bridge stent combined with aspiration embolectomy. The differences in serum levels of inflammatory mediators, chemokines and nerve function-related indexes were compared between the two groups before treatment and 24h after embolectomy. Results: Before treatment, the differences in serum levels of inflammatory mediators, chemokines and nerve function-related indexes were not significant between the two groups. 24h after embolectomy, serum inflammatory mediators sICAM-1, hs-CRP and TNF-α levels of study group were lower than those of control group;serum chemokines CXCL16, Fractalkine and MCP-1 contents were lower than those of control group;serum nerve function-related indexes IGF-1, BDNF and CNTF levels were higher than those of control group whereas NSE level was lower than that of control group. Conclusion:Intravenous thrombolysis bridge stent combined with aspiration embolectomy can effectively reduce the systemic inflammatory response and optimize the nerve function in patients with intracranial macrovascular infarction.展开更多
Objective: To explore the clinical effectiveness of combined use of intravenous pain pump with Parecoxib injection in alleviating pain in patients during the early postoperative period after thoracoscopic surgery. Met...Objective: To explore the clinical effectiveness of combined use of intravenous pain pump with Parecoxib injection in alleviating pain in patients during the early postoperative period after thoracoscopic surgery. Methods: Eighty patients who underwent thoracoscopic surgery in a tertiary hospital were selected as the study subjects and randomly divided into two groups, with 40 patients in each group. The control group received routine postoperative treatment with intravenous pain pump, while the experimental group received Parecoxib in addition to the standard postoperative pain pump treatment. Visual Analog Scale (VAS) pain scores were used to evaluate postoperative pain relief in both groups, along with adverse reactions, postoperative complications, and patient satisfaction with pain relief. Results: Patients who received Parecoxib injection in addition to the routine use of intravenous pain pump had VAS pain scores lower than 3 points at 6 h, 12 h, 24 h, and 36 h postoperatively compared to those in the control group. The incidence of postoperative lung collapse, pleural effusion, and pulmonary infections was also significantly lower in the experimental group. The differences between the two groups were statistically significant (P Conclusion: Early combined use of Parecoxib injection in the early postoperative period after thoracoscopic surgery has shown good clinical efficacy. It can reduce the level of pain in patients, promote effective coughing and expectoration, facilitate early mobilization of patients, improve patient compliance, reduce complications, shorten hospital stay, and expedite patient recovery. Therefore, it is worth promoting the widespread clinical application of Parecoxib injection in this setting.展开更多
Objective: To explore the effectiveness of applying patient simulators combined with Internet Plus scenario simulation teaching models on intravenous (IV) infusion nursing education, and to provide scientific evidence...Objective: To explore the effectiveness of applying patient simulators combined with Internet Plus scenario simulation teaching models on intravenous (IV) infusion nursing education, and to provide scientific evidence for the implementation of advanced teaching models in future nursing education. Methods: Enrolled 60 nurses who took the IV infusion therapy training program in our hospital from January 2022 to December 2023 for research. 30 nurses who were trained in traditional teaching models from January to December 2022 were selected as the control group, and 30 nurses who were trained with simulation-based teaching models with methods including simulated patients, internet, online meetings which can be replayed and scenario simulation, etc. from January to December 2023 were selected as the experimental group. Evaluated the learning outcomes based on the Competency Inventory for Nursing Students (CINS), Problem-Solving Inventory (PSI), comprehensive learning ability, scientific research ability, and proficiency in the theoretical knowledge and practical skills of IV infusion therapy. Nursing quality, the incidence of IV infusion therapy complications and nurse satisfaction with different teaching models were also measured. Results: The scientific research ability, PSI scores, CINS scores, and comprehensive learning ability of the experimental group were better than those of the control group (P 0.05), and their assessment results of practical skills, nursing quality of IV infusion therapy during training, and satisfaction with teaching models were all better than those of the control group with statistical significance (P < 0.05). The incidence of IV infusion therapy complications in the experimental group was lower than that in the control group, indicating statistical significance (P < 0.05). Conclusions: Teaching models based on patient simulators combined with Internet Plus scenario simulation enable nursing students to learn more directly and practice at any time and in any place, and can improve their proficiency in IV infusion theoretical knowledge and skills (e.g. PICC catheterization), core competencies, problem-solving ability, comprehensive learning ability, scientific research ability and the ability to deal with complicated cases. Also, it helps provide high-quality nursing education, improve the nursing quality of IV therapy, reduce the incidence of related complications, and ensure the safety of patients with IV therapy.展开更多
Background:Intravenous thrombolysis(IVT)is an effective way for treating acute ischemic stroke(AIS).However,its effects have not been established among AIS patients with unclear stroke symptoms or with stroke onset fo...Background:Intravenous thrombolysis(IVT)is an effective way for treating acute ischemic stroke(AIS).However,its effects have not been established among AIS patients with unclear stroke symptoms or with stroke onset for>4.5 h.Methods:We searched PubMed,Embase,Web of Science,Cochrane Central Register of Controlled Trials and Google Scholar databases for randomized controlled trials that compared IVT(IVT group)and placebo or usual care(control group[CG])in AIS patients with disease onset for>4.5 h.The outcomes of interest included the favorable functional outcome(defined as modified Rankin Scale[mRS]scores 0–1)at 90 days,the functional independence(defined as mRS scores 0–2)at 90 days,proportion of patients with symptomatic intracerebral hemorrhage(sICH)and death at 90 days.We assessed the risk of bias using the Cochrane tool.Pre-specified subgroup analyses were performed by age(70 years or>70 years),National Institute of Health Stroke Scale(NIHSS,10 or>10)and time window(4.5–9.0 h or>9.0 h).Results:Four trials involving 848 patients were eligible.The risk of bias of included trials was low.Patients in the IVT group were more likely to achieve favorable functional outcomes(45.8%vs.36.7%;OR 1.48,95%CI 1.12–1.96)and functional independence(63.8%vs.55.7%;OR 1.43,95%CI 1.08–1.90)at 90 days,but had higher risk of sICH(3.0%vs.0.5%;OR 5.28,95%CI 1.35–20.68)at 90 days than those in the CG.No significant difference in death at 90 days was found between the two groups(7.0%vs.4.1%;OR 1.80;95%CI 0.97–3.34).Conclusions:Use of IVT in patients with extended time window may improve their functional outcomes at 90 days,although IVT may induce increased risk of sICH.Care of these patients should well balance the potential benefits and harms of IVT.展开更多
Objective To investigate the risk factors of early neurological deterioration(END)after intravenous thrombolysis(IVT)in patients with acute ischemic stroke(AIS).Methods We screened consecutive AIS patients from Januar...Objective To investigate the risk factors of early neurological deterioration(END)after intravenous thrombolysis(IVT)in patients with acute ischemic stroke(AIS).Methods We screened consecutive AIS patients from January 2006 to May 2015 in Tangshan Gongren Hospital.In this study,all patients were treated with in-展开更多
Background:The occurrence of early neurological deterioration following intravenous thrombolysis(IVT)is considered a particularly ominous clinical event and is strongly correlated with poor outcomes.Initiating tirofib...Background:The occurrence of early neurological deterioration following intravenous thrombolysis(IVT)is considered a particularly ominous clinical event and is strongly correlated with poor outcomes.Initiating tirofiban within 24 h after IVT has been suggested as a better treatment option to achieve long-term functional outcomes.However,the rationality of this remedy is a controversial.The purpose of the study was to evaluate the safety and efficacy of early intravenous tirofiban administration after IVT in patients with acute ischemic stroke(AIS).Methods:Databases including PubMed,EMBASE,Cochrane Library,and Web of Science were searched for clinical trials on early tirofiban implementation after IVT in patients with AIS from inception to September 2022.Odds ratios(ORs)were generated for dichotomous variants via meta-analysis using STATA 17.0 MP.Results:Five clinical trials with 725 patients were eligible.The study outcomes demonstrated that early tirofiban administration after IVT was not associated with symptomatic intracranial hemorrhage(OR,0.78;95%confidence interval(CI),0.22–2.74;P=0.70),asymptomatic intracranial hemorrhage(OR,1.11;95%CI,0.52–2.37;P=0.80),systemic bleeding(OR,0.97;95%CI,0.42–2.23;P=0.94),and death(OR,1.05;95%CI,0.47–2.31;P=0.91),but may reduce the incidence of early neurological deterioration(OR,0.09;95%CI,0.02–0.50;P=0.01),and was significantly associated with 90-day excellent(modified Rankin scale score 0–1)(OR,2.01;95%CI,1.35–3.02;P=0.00)and favorable(modified Rankin scale score 0–2)(OR,2.30;95%CI,1.63–3.23;P=0.00)functional outcomes.Conclusion:The early intravenous administration of tirofiban after IVT in patients with AIS may be a safe and effective treatment strategy that improves long-term neurological functional outcomes without increasing the risk of adverse events.展开更多
The most effective medical treatment for acute ischaemic stroke(AIS)is to offer intravenous thrombolysis during the ultra-early period of time after the onset.Even based on the Consensus of Chinese Experts on Intraven...The most effective medical treatment for acute ischaemic stroke(AIS)is to offer intravenous thrombolysis during the ultra-early period of time after the onset.Even based on the Consensus of Chinese Experts on Intravenous Thrombolysis for AIS in 2012 and 2014 Chinese Guidelines on the Diagnosis and Treatment of AIS,the rate of thrombolysis for AIS in China remained around 2.4%,and the rate of intravenous tissue plasminogen activator usage was only about 1.6%in real world.The indication of thrombolysis for AIS has been expanded,and contraindications have been reduced with recently published studies.In order to facilitate the standardisation of treating AIS,improve the rate of thrombolysis and benefit patients who had a stroke,Chinese Stroke Association has organised and developed this scientific statement.展开更多
Objective Intravenous tissue plasminogen activator(tPA)is the standard therapy for patients with acute ischaemic stroke(AIS)within 4.5 hours of onset.Recent trials have expanded the endovascular treatment window to 24...Objective Intravenous tissue plasminogen activator(tPA)is the standard therapy for patients with acute ischaemic stroke(AIS)within 4.5 hours of onset.Recent trials have expanded the endovascular treatment window to 24 hours.We investigated the efficacy and safety of using multimodal MRI to guide intravenous tPA treatment for patients with AIS of unknown time of onset(UTO).Methods Data on patients with AIS with UTO and within 4.5 hours of onset were reviewed.Data elements collected and analysed included:demographics,National Institutes of Health Stroke Scale(NIHSS)score at baseline and 2 hours,24 hours,7 days after thrombolysis and before discharge,the modified Rankin Scale(mRS)score at 3 months after discharge,imaging findings and any adverse event.results Forty-two patients with UTO and 62 in control group treated within 4.5 hours of onset were treated with intravenous tPA.The NIHSS scores after thrombolysis and/or before discharge in UTO group were significantly improved compared with the baseline(p<0.05).Between the two groups,no significant differences in NIHSS score were observed(p>0.05).Utilising the non-inferiority test,to compare mRS scores(0-2)at 3 months between the two groups,the difference was 5.2%(92%CI,OR 0.196).Patients in the UTO group had mRS scores of 0-2,which were non-inferior to the control group.Their incidence of adverse events was similar.Conclusions Utilising multimodal MRI to guide intravenous only thrombolysis for patients with AIS with UTO was safe and effective.In those patients with AIS between 6 and 24 hours of time of onset but without large arterial occlusion,intravenous thrombolysis could be considered an option.展开更多
Background and purpose To evaluate relationship between fluid-attenuated inversion recovery vascular hyperintensity(FVH)after intravenous thrombolysis and outcomes in different lesion patterns on diffusion-weighted im...Background and purpose To evaluate relationship between fluid-attenuated inversion recovery vascular hyperintensity(FVH)after intravenous thrombolysis and outcomes in different lesion patterns on diffusion-weighted imaging(DWI).Methods Patients with severe internal carotid or intracranial artery stenosis who received intravenous thrombolysis from March 2012 to April 2019 were analysed.They were divided into four groups by DWI lesion patterns:border-zone infarct(BZ group),multiple lesions infarct(ML group),large territory infarct(LT group),and single cortical or subcortical lesion infarct(SL group).Logistic regression was performed to identify risk factors for outcome(unfavourable outcome,modified Rankin Scale(mRS)≥2;poor outcome,mRS≥3).Results Finally,203 participants(63.3±10.2 years old;BZ group,n=72;ML group,n=64;LT group,n=37;SL group,n=30)from 1190 patient cohorts were analysed.After adjusting for confounding factors,FVH(+)was associated with unfavourable outcome in total group(OR 3.02;95%CI 1.49 to 6.13;p=0.002),BZ group(OR 4.22;95%CI 1.25 to 14.25;p=0.021)and ML group(OR 5.44;95%CI 1.41 to 20.92;p=0.014)patients.FVH(+)was associated with poor outcome in total group(OR 2.25;95%CI 1.01 to 4.97;p=0.046),BZ group(OR 5.52;95%CI 0.98 to 31.07;p=0.053)and ML group(OR 4.09;95%CI 1.04 to 16.16;p=0.045)patients,which was marginal significance.FVH(+)was not associated with unfavourable or poor outcome in LT and SL groups.Conclusion This study suggests that association between FVH and outcome varies with different lesion patterns on DWI.The presence of FVH after intravenous thrombolysis may help to identify patients who require close observations in the hospitalisation in patients with border-zone and multiple lesion infarcts.展开更多
background and purpose Early neurological deterioration(END)is a common feature in patients with acute ischaemic stroke(AIS)receiving thrombolysis.This study aimed to investigate whether the presence of multiple hypoi...background and purpose Early neurological deterioration(END)is a common feature in patients with acute ischaemic stroke(AIS)receiving thrombolysis.This study aimed to investigate whether the presence of multiple hypointense vessels(MHVs)on susceptibility-weighted imaging(SWI)could predict END in patients with the anterior circulation AIS treated with recombinant tissue plasminogen activator(r-tPA).Methods This was a retrospective study focusing on AIS patients suffering from symptomatic stenosis or occlusion of the middle cerebral artery or internal carotid artery with r-tPA treatment.We collected clinical variables and initial haematological and neuroimaging findings.MHVs were measured on SWI performed after intravenous thrombosis and were defined as the presence of a greater number of veins or veins of a larger diameter with greater signal loss on SWI than those of the contralesional haemisphere.The degree of hyperintensity of MHVs was classified into four grades:none,subtle,moderate and extensive.END was defined as an increase in the National Institutes of Health Stroke Scale score by 2 points during the first 48 hours after the onset of symptoms.Multivariate logistic regressions were conducted to investigate the predictors of END.results The study included 61 patients(51 males and 10 females)with a mean age of 62.4±12.6 years.Thirty-five(57.4%)patients presented with MHVs:8(13.1%)were graded as subtle MHVs,while 23(37.7%)and 4(6.6%)were graded as moderate or extensive MHVs,respectively.Twenty patients(32.8%)presented with END.Logistic regression analysis showed that compared with patients without MHVs,moderate MHVs(adjusted OR 5.446,95%CI 1.360 to 21.800;p=0.017)and extensive MHVs(adjusted OR 15.240,95%CI 1.200 to 193.544;p=0.036)were significantly associated with END.Conclusions MHVs might be a useful predictor of END in AIS patients with symptomatic large artery stenosis or occlusion after r-tPA treatment.展开更多
Background and purpose Previous studies have reported conflicting results as to whether women have poorer functional outcome than men after thrombolytic therapy.This study aims to investigate the relationship between ...Background and purpose Previous studies have reported conflicting results as to whether women have poorer functional outcome than men after thrombolytic therapy.This study aims to investigate the relationship between sex differences and the prognosis of intravenous thrombolysis in Chinese patients with acute ischaemic stroke.Methods The patients enrolled in this study were from the Chinese Acute Ischemic Stroke Thrombolysis Monitoring and Registration study.The primary outcome was poor functional outcome,defined as a 3-month modified Rankin score of 3-6.The safe outcome was symptomatic intracranial haemorrhage(SICH)and mortality within 7 days and 90 days.Multiple Cox regression model was used to correct the potential covariates to evaluate the association between sex disparities and prognosis.Furthermore,the interaction of preonset Rankin scores,baseline National Institute of Health Stroke Scale(NIHSS)scores and Trial of Org 10172 in Acute Stroke Treatment(TOAST)types was statistically analysed.results A total of 1440 patients were recruited,including 541 women and 899 men.The baseline information indicated that women were older at the time of onset(66.2±11.2 years vs 61.0±11.3 years,p<0.001),and more likely to have a history of atrial fibrillation(25.3%vs 11.2%,p<0.001),and had a higher NIHSS score on admission(12.3±6.8 vs 11.6±6.7,p=0.04).According to the prognosis analysis of unsatisfactory functional recovery,there was no significant difference between women and men(45.9%vs 37.1%;adjusted OR 1.01,95%CI 0.75 to 1.37).As for the safe outcome,the proportion of SICH and mortality in women is relatively high but did not reach statistical significance.There was no significant interaction with sex,age,preonset Rankin score,NIHSS score,TOAST classification and the prognosis of intravenous thrombolysis.Conclusions For Chinese patients with ischaemic stroke,although women are older and more severe at the time of onset,the prognosis after intravenous thrombolysis is not significantly different from men.展开更多
Background The number of mobile stroke programmes has increased with evidence,showing they expedite intravenous thrombolysis.Outstanding questions include whether time savings extend to patients eligible for endovascu...Background The number of mobile stroke programmes has increased with evidence,showing they expedite intravenous thrombolysis.Outstanding questions include whether time savings extend to patients eligible for endovascular therapy and impact clinical outcomes.Objective Our mobile stroke unit(MSU),based at an academic medical centre in upstate New York,launched in October 2018.We reviewed prospective observational data sets over 26 months to identify MSU and non-MSU emergency medical service(EMS)patients who underwent intravenous thrombolysis or endovascular thrombectomy for comparison of angiographic and clinical outcomes.Results Over 568 days in service,the MSU was dispatched 1489 times(2.6/day)and transported 300 patients(20%of dispatches).Intravenous tissue plasminogen activator(tPA)was administered to 57 MSU patients and the average time from 911 call-to tPA was 42.5 min(±9.2),while EMS transported 73 patients who received tPA at 99.4 min(±35.7)(p<0.001).Seven MSU patients(12%)received tPA from 3.5 hours to 4.5 hours since last known well and would likely have been outside the window with EMS care.Endovascular thrombectomy was performed on 21 MSU patients with an average 911 call-to groin puncture time of 99.9 min(±18.1),while EMS transported 54 patients who underwent endovascular thrombectomy(ET)at 133.0 min(±37.0)(p=0.0002).There was no difference between MSU and traditional EMS in modified Rankin score at 90-day clinic follow-up for patients undergoing intravenous thrombolysis or endovascular thrombectomy,whether assessed as a dichotomous or ordinal variable.Conclusions Mobile stroke care expedited both intravenous thrombolysis and endovascular thrombectomy.There is an ongoing need to show improved functional outcomes with MSU care.展开更多
Objective To investigate the efficacy and safety of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in acute cerebral infarct patients with atrial fibrillation (AF) and the predicting fa...Objective To investigate the efficacy and safety of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in acute cerebral infarct patients with atrial fibrillation (AF) and the predicting factors of poor prognosis.Methods Totally 162 patients with acute cerebral infarct were treated with rt-PA within 4.5hours from the onset.According to past history and the electrocardiogram,the patients was classified into展开更多
The authors report the first case of thrombolysis in a patient already receiving both aspirin and prasugrel following a recent ischemic coronary event. A 55-year-old gentleman was treated for inferior wall myocardial ...The authors report the first case of thrombolysis in a patient already receiving both aspirin and prasugrel following a recent ischemic coronary event. A 55-year-old gentleman was treated for inferior wall myocardial infarction with aspirin, prasugrel and percutaneous angioplasty of right coronary artery. Three days following the procedure he developed acute ischemic stroke due to a left middle cerebral artery infarction with a National Institute of Health Stroke Scale (NIHSS) of 24 and was treated with alteplase. Therapy was interrupted after completion of 29 mg (for a body weight of 65 kg) dose due to oral bleeding. Fifteen minutes post thrombolysis NIHSS was 5 and dropped to zero after 12 h. This report highlights the benefits of alteplase in the context of several relative contraindications like the setting of acute myocardial infarction treated with percutaneous intervention and high NIHSS.展开更多
Aim: Stroke is one of the leading causes of death and disability. The proportion of patients receiving recombinant tissue plasminogen activator is low in our country. Biomarkers to identify patients at risk of severe ...Aim: Stroke is one of the leading causes of death and disability. The proportion of patients receiving recombinant tissue plasminogen activator is low in our country. Biomarkers to identify patients at risk of severe disease, and guide treatment and prognosis would be valuable. This article aims to identify the factors that can independently prognosticate the acute phase of ischemic stroke. Methods: All patients with the first episode of ischemic stroke admitted to the Neurology Department between 1st December 2017 to 31st March 2018 were included in this pilot study. Stroke severity was evaluated using the National Institute of Health Stroke Scale (NIHSS). Patients being admitted within 4.5 h of onset of symptoms were thrombolysed with injection alteplase. For each patient, 4 serum biomarkers (D-dimer, fibrinogen, C-reactive pro-tein and neuron specific enolase) were evaluated at admission and 24 h later. Discharged patients were assessed on an outpatient basis using the modified Rankin scale. The study primarily aimed to identify the factors predicting the severity and outcome of stroke, and to evaluate the effect of thrombolysis on the outcome. The secondary aim was to evaluate the role of biomarkers to predict the unfavorable outcome and the chance of post thrombolysis hemor-rhage. Results: Out of 30 patients included in the study, 10 had NIHSS 0-4, 12 had NIHSS 5-15 and 8 had NIHSS 16-42. Sixteen patients had unfavorable outcome (mRS score ≥ 2), and 5 patients expired. Old age, history of diabetes, CHADS2 score ≥ 2, and total anterior circulation stroke (TACS) independently affected stroke severity, whereas lowejection fraction < 35%, and TACS, independently predicted unfavorable outcome and mortality. High mean arte-rial blood pressure (MABP) and capillary blood glucose (CBG) at admission were significant predictors of stroke severity, unfavorable outcome, and mortality. Out of 10 thrombolysed patients, two had mRS score ≥ 2 and 3 had the post-thrombolysis hemorrhage. Thrombolysis significantly reduced the incidence of the unfavorable outcome, but did not significantly affect death. All the biomarker levels at admission were significantly higher among patients with severe stroke and those who subsequently had an unfavorable outcome. D-dimer levels significantly increased and fibrinogen level significantly decreased following thrombolysis. Higher MABP, CBG, and fibrinogen levels at ad-mission predicted significantly higher chance to develop hemorrhagic complications post thrombolysis. Conclusion: Low ejection fraction, occurrence of TACS and the higher levels of the biomarkers under study pre-dicted poor outcome. Higher mean CBG and MABP and raised fibrinogen levels predicted higher chance of post-thrombolysis hemorrhage.展开更多
文摘Objective:Discussion and analysis of the effect of the early application of Tirofiban on acute ischemic stroke(AIS)after intravenous thrombolysis with urokinase.Method:The subjects of this study are 40 patients with AIS admitted at the Yibin Fourth People’s Hospital,of which were computer-randomized into a control group(20 cases,with regular urokinase intravenous thrombolysis therapy)and a research group(20 cases,combined with early Tirofiban treatment)from January 2018 to December 2022.The intervention outcomes between these two groups were compared and analyzed.Result:The blood platelet-related parameters before treatment had no statistical difference between the two groups(P>0.05),but the research group was higher than that of the control group after treatment(P<0.05).The Barthel index before treatment in both groups had no statistical difference(P>0.05),but the research group was higher than that of the control group after treatment(P<0.05).Conclusion:Early Tirofiban treatment for patients with AIS after intravenous thrombolysis with urokinase could effectively regulate the blood platelet-related parameters,hence improving treatment benefits and living capacity for patients,with definite clinical benefits.
文摘BACKGROUND Left ventricular thrombus is a rare condition,for which appropriate treatments are not extensively studied.Although it can be treated by thrombectomy,such surgery can be difficult and risky,and not every patient can tolerate the surgery.CASE SUMMARY We report a case of a middle-aged man receiving veno-arterial extracorporeal membrane oxygenation(VA-ECMO)for acute myocardial infarction who developed left ventricular thrombus despite systemic anticoagulation.After systemic thrombolysis with urokinase,the left ventricular thrombus disappeared,ECMO was successfully withdrawn 9 days later,and the patient recovered and was discharged from hospital.CONCLUSION Systemic thrombolysis is a treatment option for left ventricular thrombus in addition to anticoagulation and thrombectomy.
基金Major Project of Shanghai Science and Technology Commission (Sub-project) No: 11411950300
文摘Objective: To investigate the effects of butyphthalide + alteplase (rt-PA) intravenous thrombolysis on the diffusion-weighted imaging (DWI) characteristics, coagulation function and neurological function in patients with acute cerebral infarction. Methods: The patients with acute cerebral infarction who were admitted to our hospital between April 2015 and October 2018 and with the onset time 4.5 hours were selected and divided into the observation group receiving butyphthalide + rt-PA intravenous thrombolysis and the control group receiving rt-PA intravenous thrombolysis by random number table. The differences in DWI parameter apparent diffusion coefficient (ADC), coagulation function indexes and neurological function indexes were compared between the two groups. Results: At 7 and 14 days after treatment, the ADC values of both groups were significantly increased, and the ADC values of the observation group were significantly higher than those of the control group;at 7 days after treatment, the prothrombin time (PT) and activated partial thromboplastin time (APTT) levels in both groups were significantly prolonged whereas fibrinogen (FIB), D-dimer (D-D), platelet activating factor (PAF), P-selectin, von Willebrand factor (vWF), neuron-specific enolase (NSE), S100B protein (S100B), malondialdehyde (MDA) and endothelin-1 (ET-1) contents were significantly decreased, and the APTT and PT levels in the observation group were significantly shorter than those in the control group whereas FIB, D-D, PAF, P-selectin, vWF, NSE, S100B, MDA and ET-1 contents were significantly lower than those in the control group. Conclusion: Butyphthalide + rt-PA intravenous thrombolysis can improve the DWI characteristics, coagulation function and neurological function of patients with acute cerebral infarction.
基金Military Program of Medicine and Hygiene, No.06H001
文摘BACKGROUND:Studies have demonstrated that immediate anticoagulation after thrombolysis can improve the prognosis of patients with acute cerebral infarction. However,the optimal timing and means of anticoagulation therapy remain unclear. OBJECTIVE:To observe the effects and safety of heparin treatment within 24 hours after intravenous thrombolysis for acute cerebral infarction. DESIGN:Observation experiment. SETTING:Department of Neurology,the 306 Hospital of Chinese PLA. PARTICIPANTS:Fifteen acute cerebral infarction patients complicated by moderate and severe neurologic function deficits within 6 hours after attack admitted to Department of Neurology,the 306 Hospital of Chinese PLA between January 2005 and December 2006 were recruited in this study. The involved patients,11 male and 4 female,were aged 46-79 years. They all met the diagnosis criteria for various cerebrovascular diseases formulated by the 4th National Conference for Cerebrovascular Disease(1995) and confirmed as cerebral infarction by skull CT or MRI imageology. Informed consents were obtained from the patients or their relatives. METHODS:On admission,patients received thrombolysis with urokinase. Immediately after thrombolysis,skull CT was rechecked. Intracranial hemorrhage signs were not found by skull CT. Hemorrhage was also not found in skin,mucous membrane and internal organs. Six hours later,low-dose low-intensity heparin 4-8 IU/kg per hour was intravenously administrated for anticoagulation for 7-10 days successively. MAIN OUTCOME MEASURES:Neurologic function was evaluated before,immediately 6 hours and 14 days after thrombolysis by scoring standard of clinical neurologic function deficit degree for stroke patients(1995). Activities of daily living of patients with stroke were evaluated 90 days after thrombolysis by modified Rankin Scale. RESULTS:Fifteen involved patients participated in the final analysis. ① Comparison of clinical neurologic function deficit degree of patients at different time:Neurologic function deficit score at the end of thrombolysis was significantly lower than that before thrombolysis(t =3.45,P < 0.01). Neurologic function deficit score 6 hours after thrombolysis was higher than that at the end of thrombolysis,and neurologic deficits were increased,but no significant difference was found(P > 0.05). Neurologic function deficit score 14 days after thrombolysis was significantly lower than that before thrombolysis(t =4.769,P < 0.01). ② Therapeutic effect and modified Rankin scale results:14 days after thrombolysis,4 patients were basically cured,7 significantly improved,2 improved and 2 worsened. The total improvement rate of neurologic function deficit was 86.7%. Ninety days after thrombolysis,according to modified Rankin Scale,score was 0 to 2 in 12 patients(80%),3 to 4 in 2 patients(13.3%) and 6 in 1 patient(6.7%). Complications of intracranial hemorrhage were not found in patients within 14 days after thrombolysis. CONCLUSION:Low-dose and low-intensity heparin applied within 24 hours after intravenous thrombolysis has good safety and efficacy in the treatment of acute cerebral infarction.
文摘Objective: To explore the efficacy of mild hypothermia + intravenous thrombolysis in promoting the neural functional recovery in patients with acute cerebral infarction. Methods: A total of 176 patients with acute cerebral infarction who were treated in our hospital between September 2015 and February 2017 were reviewed and divided into the routine group (n=100 cases, receiving routine intravenous thrombolysis therapy) and the mild hypothermia group (n=76, receiving mild hypothermia + intravenous thrombolysis therapy), and the treatment lasted for 1 week. The differences in serum levels of nerve injury indexes, inflammatory mediators and neurotransmitters were compared between the two groups before treatment and after 1 week of treatment. Results: Before treatment, there was no statistically significant difference in serum levels of nerve injury indexes, inflammatory mediators and neurotransmitters between the two groups. After 1 week of treatment, serum nerve injury indexes H-FABP, NT-proBNP, NSE and S100B levels of mild hypothermia group were lower than those of routine group;inflammatory mediators sICAM-1, IL-8, IL-13 and IL-18 levels were lower than those of routine group;neurotransmitter Glu level was lower than that of routine group whereas GABA level was higher than that of routine group. Conclusion: mild hypothermia + intravenous thrombolysis therapy can effectively reduce the nerve injury and systemic inflammatory response, and optimize the neurotransmitter distribution in patients with acute cerebral infarction.
基金Projects of Natural Science Foundation of Tibet Autonomous Region.Project No:2015ZR-13-16.
文摘Objective: To explore the effect of intravenous thrombolysis bridge stent combined with aspiration embolectomy on serological indicators in patients with intracranial macrovascular infarction. Methods: 92 patients with intracranial macrovascular infarction who received treatment in our hospital between February 2016 and January 2018 were selected as the research subjects and divided into the control group (n=46) and the study group (n=46) by random number table method. Control group received stent embolectomy alone, and study group received intravenous thrombolysis bridge stent combined with aspiration embolectomy. The differences in serum levels of inflammatory mediators, chemokines and nerve function-related indexes were compared between the two groups before treatment and 24h after embolectomy. Results: Before treatment, the differences in serum levels of inflammatory mediators, chemokines and nerve function-related indexes were not significant between the two groups. 24h after embolectomy, serum inflammatory mediators sICAM-1, hs-CRP and TNF-α levels of study group were lower than those of control group;serum chemokines CXCL16, Fractalkine and MCP-1 contents were lower than those of control group;serum nerve function-related indexes IGF-1, BDNF and CNTF levels were higher than those of control group whereas NSE level was lower than that of control group. Conclusion:Intravenous thrombolysis bridge stent combined with aspiration embolectomy can effectively reduce the systemic inflammatory response and optimize the nerve function in patients with intracranial macrovascular infarction.
文摘Objective: To explore the clinical effectiveness of combined use of intravenous pain pump with Parecoxib injection in alleviating pain in patients during the early postoperative period after thoracoscopic surgery. Methods: Eighty patients who underwent thoracoscopic surgery in a tertiary hospital were selected as the study subjects and randomly divided into two groups, with 40 patients in each group. The control group received routine postoperative treatment with intravenous pain pump, while the experimental group received Parecoxib in addition to the standard postoperative pain pump treatment. Visual Analog Scale (VAS) pain scores were used to evaluate postoperative pain relief in both groups, along with adverse reactions, postoperative complications, and patient satisfaction with pain relief. Results: Patients who received Parecoxib injection in addition to the routine use of intravenous pain pump had VAS pain scores lower than 3 points at 6 h, 12 h, 24 h, and 36 h postoperatively compared to those in the control group. The incidence of postoperative lung collapse, pleural effusion, and pulmonary infections was also significantly lower in the experimental group. The differences between the two groups were statistically significant (P Conclusion: Early combined use of Parecoxib injection in the early postoperative period after thoracoscopic surgery has shown good clinical efficacy. It can reduce the level of pain in patients, promote effective coughing and expectoration, facilitate early mobilization of patients, improve patient compliance, reduce complications, shorten hospital stay, and expedite patient recovery. Therefore, it is worth promoting the widespread clinical application of Parecoxib injection in this setting.
文摘Objective: To explore the effectiveness of applying patient simulators combined with Internet Plus scenario simulation teaching models on intravenous (IV) infusion nursing education, and to provide scientific evidence for the implementation of advanced teaching models in future nursing education. Methods: Enrolled 60 nurses who took the IV infusion therapy training program in our hospital from January 2022 to December 2023 for research. 30 nurses who were trained in traditional teaching models from January to December 2022 were selected as the control group, and 30 nurses who were trained with simulation-based teaching models with methods including simulated patients, internet, online meetings which can be replayed and scenario simulation, etc. from January to December 2023 were selected as the experimental group. Evaluated the learning outcomes based on the Competency Inventory for Nursing Students (CINS), Problem-Solving Inventory (PSI), comprehensive learning ability, scientific research ability, and proficiency in the theoretical knowledge and practical skills of IV infusion therapy. Nursing quality, the incidence of IV infusion therapy complications and nurse satisfaction with different teaching models were also measured. Results: The scientific research ability, PSI scores, CINS scores, and comprehensive learning ability of the experimental group were better than those of the control group (P 0.05), and their assessment results of practical skills, nursing quality of IV infusion therapy during training, and satisfaction with teaching models were all better than those of the control group with statistical significance (P < 0.05). The incidence of IV infusion therapy complications in the experimental group was lower than that in the control group, indicating statistical significance (P < 0.05). Conclusions: Teaching models based on patient simulators combined with Internet Plus scenario simulation enable nursing students to learn more directly and practice at any time and in any place, and can improve their proficiency in IV infusion theoretical knowledge and skills (e.g. PICC catheterization), core competencies, problem-solving ability, comprehensive learning ability, scientific research ability and the ability to deal with complicated cases. Also, it helps provide high-quality nursing education, improve the nursing quality of IV therapy, reduce the incidence of related complications, and ensure the safety of patients with IV therapy.
文摘Background:Intravenous thrombolysis(IVT)is an effective way for treating acute ischemic stroke(AIS).However,its effects have not been established among AIS patients with unclear stroke symptoms or with stroke onset for>4.5 h.Methods:We searched PubMed,Embase,Web of Science,Cochrane Central Register of Controlled Trials and Google Scholar databases for randomized controlled trials that compared IVT(IVT group)and placebo or usual care(control group[CG])in AIS patients with disease onset for>4.5 h.The outcomes of interest included the favorable functional outcome(defined as modified Rankin Scale[mRS]scores 0–1)at 90 days,the functional independence(defined as mRS scores 0–2)at 90 days,proportion of patients with symptomatic intracerebral hemorrhage(sICH)and death at 90 days.We assessed the risk of bias using the Cochrane tool.Pre-specified subgroup analyses were performed by age(70 years or>70 years),National Institute of Health Stroke Scale(NIHSS,10 or>10)and time window(4.5–9.0 h or>9.0 h).Results:Four trials involving 848 patients were eligible.The risk of bias of included trials was low.Patients in the IVT group were more likely to achieve favorable functional outcomes(45.8%vs.36.7%;OR 1.48,95%CI 1.12–1.96)and functional independence(63.8%vs.55.7%;OR 1.43,95%CI 1.08–1.90)at 90 days,but had higher risk of sICH(3.0%vs.0.5%;OR 5.28,95%CI 1.35–20.68)at 90 days than those in the CG.No significant difference in death at 90 days was found between the two groups(7.0%vs.4.1%;OR 1.80;95%CI 0.97–3.34).Conclusions:Use of IVT in patients with extended time window may improve their functional outcomes at 90 days,although IVT may induce increased risk of sICH.Care of these patients should well balance the potential benefits and harms of IVT.
文摘Objective To investigate the risk factors of early neurological deterioration(END)after intravenous thrombolysis(IVT)in patients with acute ischemic stroke(AIS).Methods We screened consecutive AIS patients from January 2006 to May 2015 in Tangshan Gongren Hospital.In this study,all patients were treated with in-
基金supported by the Natural Science Foundation of Inner Mongolia(No.2021MS08169)the Medical and health Science and Technology Project of Inner Mongolia(No.202201571).
文摘Background:The occurrence of early neurological deterioration following intravenous thrombolysis(IVT)is considered a particularly ominous clinical event and is strongly correlated with poor outcomes.Initiating tirofiban within 24 h after IVT has been suggested as a better treatment option to achieve long-term functional outcomes.However,the rationality of this remedy is a controversial.The purpose of the study was to evaluate the safety and efficacy of early intravenous tirofiban administration after IVT in patients with acute ischemic stroke(AIS).Methods:Databases including PubMed,EMBASE,Cochrane Library,and Web of Science were searched for clinical trials on early tirofiban implementation after IVT in patients with AIS from inception to September 2022.Odds ratios(ORs)were generated for dichotomous variants via meta-analysis using STATA 17.0 MP.Results:Five clinical trials with 725 patients were eligible.The study outcomes demonstrated that early tirofiban administration after IVT was not associated with symptomatic intracranial hemorrhage(OR,0.78;95%confidence interval(CI),0.22–2.74;P=0.70),asymptomatic intracranial hemorrhage(OR,1.11;95%CI,0.52–2.37;P=0.80),systemic bleeding(OR,0.97;95%CI,0.42–2.23;P=0.94),and death(OR,1.05;95%CI,0.47–2.31;P=0.91),but may reduce the incidence of early neurological deterioration(OR,0.09;95%CI,0.02–0.50;P=0.01),and was significantly associated with 90-day excellent(modified Rankin scale score 0–1)(OR,2.01;95%CI,1.35–3.02;P=0.00)and favorable(modified Rankin scale score 0–2)(OR,2.30;95%CI,1.63–3.23;P=0.00)functional outcomes.Conclusion:The early intravenous administration of tirofiban after IVT in patients with AIS may be a safe and effective treatment strategy that improves long-term neurological functional outcomes without increasing the risk of adverse events.
文摘The most effective medical treatment for acute ischaemic stroke(AIS)is to offer intravenous thrombolysis during the ultra-early period of time after the onset.Even based on the Consensus of Chinese Experts on Intravenous Thrombolysis for AIS in 2012 and 2014 Chinese Guidelines on the Diagnosis and Treatment of AIS,the rate of thrombolysis for AIS in China remained around 2.4%,and the rate of intravenous tissue plasminogen activator usage was only about 1.6%in real world.The indication of thrombolysis for AIS has been expanded,and contraindications have been reduced with recently published studies.In order to facilitate the standardisation of treating AIS,improve the rate of thrombolysis and benefit patients who had a stroke,Chinese Stroke Association has organised and developed this scientific statement.
文摘Objective Intravenous tissue plasminogen activator(tPA)is the standard therapy for patients with acute ischaemic stroke(AIS)within 4.5 hours of onset.Recent trials have expanded the endovascular treatment window to 24 hours.We investigated the efficacy and safety of using multimodal MRI to guide intravenous tPA treatment for patients with AIS of unknown time of onset(UTO).Methods Data on patients with AIS with UTO and within 4.5 hours of onset were reviewed.Data elements collected and analysed included:demographics,National Institutes of Health Stroke Scale(NIHSS)score at baseline and 2 hours,24 hours,7 days after thrombolysis and before discharge,the modified Rankin Scale(mRS)score at 3 months after discharge,imaging findings and any adverse event.results Forty-two patients with UTO and 62 in control group treated within 4.5 hours of onset were treated with intravenous tPA.The NIHSS scores after thrombolysis and/or before discharge in UTO group were significantly improved compared with the baseline(p<0.05).Between the two groups,no significant differences in NIHSS score were observed(p>0.05).Utilising the non-inferiority test,to compare mRS scores(0-2)at 3 months between the two groups,the difference was 5.2%(92%CI,OR 0.196).Patients in the UTO group had mRS scores of 0-2,which were non-inferior to the control group.Their incidence of adverse events was similar.Conclusions Utilising multimodal MRI to guide intravenous only thrombolysis for patients with AIS with UTO was safe and effective.In those patients with AIS between 6 and 24 hours of time of onset but without large arterial occlusion,intravenous thrombolysis could be considered an option.
基金This study was funded by the National Natural Science Foundation of China(8191101305).
文摘Background and purpose To evaluate relationship between fluid-attenuated inversion recovery vascular hyperintensity(FVH)after intravenous thrombolysis and outcomes in different lesion patterns on diffusion-weighted imaging(DWI).Methods Patients with severe internal carotid or intracranial artery stenosis who received intravenous thrombolysis from March 2012 to April 2019 were analysed.They were divided into four groups by DWI lesion patterns:border-zone infarct(BZ group),multiple lesions infarct(ML group),large territory infarct(LT group),and single cortical or subcortical lesion infarct(SL group).Logistic regression was performed to identify risk factors for outcome(unfavourable outcome,modified Rankin Scale(mRS)≥2;poor outcome,mRS≥3).Results Finally,203 participants(63.3±10.2 years old;BZ group,n=72;ML group,n=64;LT group,n=37;SL group,n=30)from 1190 patient cohorts were analysed.After adjusting for confounding factors,FVH(+)was associated with unfavourable outcome in total group(OR 3.02;95%CI 1.49 to 6.13;p=0.002),BZ group(OR 4.22;95%CI 1.25 to 14.25;p=0.021)and ML group(OR 5.44;95%CI 1.41 to 20.92;p=0.014)patients.FVH(+)was associated with poor outcome in total group(OR 2.25;95%CI 1.01 to 4.97;p=0.046),BZ group(OR 5.52;95%CI 0.98 to 31.07;p=0.053)and ML group(OR 4.09;95%CI 1.04 to 16.16;p=0.045)patients,which was marginal significance.FVH(+)was not associated with unfavourable or poor outcome in LT and SL groups.Conclusion This study suggests that association between FVH and outcome varies with different lesion patterns on DWI.The presence of FVH after intravenous thrombolysis may help to identify patients who require close observations in the hospitalisation in patients with border-zone and multiple lesion infarcts.
基金supported by the Medical Scientific Research Foundation of Guangdong Province,China(Reference number:A2018322).
文摘background and purpose Early neurological deterioration(END)is a common feature in patients with acute ischaemic stroke(AIS)receiving thrombolysis.This study aimed to investigate whether the presence of multiple hypointense vessels(MHVs)on susceptibility-weighted imaging(SWI)could predict END in patients with the anterior circulation AIS treated with recombinant tissue plasminogen activator(r-tPA).Methods This was a retrospective study focusing on AIS patients suffering from symptomatic stenosis or occlusion of the middle cerebral artery or internal carotid artery with r-tPA treatment.We collected clinical variables and initial haematological and neuroimaging findings.MHVs were measured on SWI performed after intravenous thrombosis and were defined as the presence of a greater number of veins or veins of a larger diameter with greater signal loss on SWI than those of the contralesional haemisphere.The degree of hyperintensity of MHVs was classified into four grades:none,subtle,moderate and extensive.END was defined as an increase in the National Institutes of Health Stroke Scale score by 2 points during the first 48 hours after the onset of symptoms.Multivariate logistic regressions were conducted to investigate the predictors of END.results The study included 61 patients(51 males and 10 females)with a mean age of 62.4±12.6 years.Thirty-five(57.4%)patients presented with MHVs:8(13.1%)were graded as subtle MHVs,while 23(37.7%)and 4(6.6%)were graded as moderate or extensive MHVs,respectively.Twenty patients(32.8%)presented with END.Logistic regression analysis showed that compared with patients without MHVs,moderate MHVs(adjusted OR 5.446,95%CI 1.360 to 21.800;p=0.017)and extensive MHVs(adjusted OR 15.240,95%CI 1.200 to 193.544;p=0.036)were significantly associated with END.Conclusions MHVs might be a useful predictor of END in AIS patients with symptomatic large artery stenosis or occlusion after r-tPA treatment.
基金supported by grants from the National Natural Science Foundation of China(81901177,81971091)Beijing Hospitals Authority Youth Programme(QML20190501)+5 种基金Ministry of Science and Technology of the People’s Republic of China(2016YFC0901002,2016YFC0901001,2017YFC1310901,2017YFC1310902,2017YFC1307905,2018YFC1312903,2018YFC1311700 and 2018YFC1311706)Beijing Municipal Administration of Hospitals(SML20150502)Beijing Municipal Science&Technology Commission(D171100003017002,D151100002015003)National Science and Technology Major Project(2017ZX09304018)Beijing Tiantan Hospital,Capital Medical University(2018-YQN-1,2020MP01)Young Elite Scientist Sponsorship Program(2020QNRC001).
文摘Background and purpose Previous studies have reported conflicting results as to whether women have poorer functional outcome than men after thrombolytic therapy.This study aims to investigate the relationship between sex differences and the prognosis of intravenous thrombolysis in Chinese patients with acute ischaemic stroke.Methods The patients enrolled in this study were from the Chinese Acute Ischemic Stroke Thrombolysis Monitoring and Registration study.The primary outcome was poor functional outcome,defined as a 3-month modified Rankin score of 3-6.The safe outcome was symptomatic intracranial haemorrhage(SICH)and mortality within 7 days and 90 days.Multiple Cox regression model was used to correct the potential covariates to evaluate the association between sex disparities and prognosis.Furthermore,the interaction of preonset Rankin scores,baseline National Institute of Health Stroke Scale(NIHSS)scores and Trial of Org 10172 in Acute Stroke Treatment(TOAST)types was statistically analysed.results A total of 1440 patients were recruited,including 541 women and 899 men.The baseline information indicated that women were older at the time of onset(66.2±11.2 years vs 61.0±11.3 years,p<0.001),and more likely to have a history of atrial fibrillation(25.3%vs 11.2%,p<0.001),and had a higher NIHSS score on admission(12.3±6.8 vs 11.6±6.7,p=0.04).According to the prognosis analysis of unsatisfactory functional recovery,there was no significant difference between women and men(45.9%vs 37.1%;adjusted OR 1.01,95%CI 0.75 to 1.37).As for the safe outcome,the proportion of SICH and mortality in women is relatively high but did not reach statistical significance.There was no significant interaction with sex,age,preonset Rankin score,NIHSS score,TOAST classification and the prognosis of intravenous thrombolysis.Conclusions For Chinese patients with ischaemic stroke,although women are older and more severe at the time of onset,the prognosis after intravenous thrombolysis is not significantly different from men.
文摘Background The number of mobile stroke programmes has increased with evidence,showing they expedite intravenous thrombolysis.Outstanding questions include whether time savings extend to patients eligible for endovascular therapy and impact clinical outcomes.Objective Our mobile stroke unit(MSU),based at an academic medical centre in upstate New York,launched in October 2018.We reviewed prospective observational data sets over 26 months to identify MSU and non-MSU emergency medical service(EMS)patients who underwent intravenous thrombolysis or endovascular thrombectomy for comparison of angiographic and clinical outcomes.Results Over 568 days in service,the MSU was dispatched 1489 times(2.6/day)and transported 300 patients(20%of dispatches).Intravenous tissue plasminogen activator(tPA)was administered to 57 MSU patients and the average time from 911 call-to tPA was 42.5 min(±9.2),while EMS transported 73 patients who received tPA at 99.4 min(±35.7)(p<0.001).Seven MSU patients(12%)received tPA from 3.5 hours to 4.5 hours since last known well and would likely have been outside the window with EMS care.Endovascular thrombectomy was performed on 21 MSU patients with an average 911 call-to groin puncture time of 99.9 min(±18.1),while EMS transported 54 patients who underwent endovascular thrombectomy(ET)at 133.0 min(±37.0)(p=0.0002).There was no difference between MSU and traditional EMS in modified Rankin score at 90-day clinic follow-up for patients undergoing intravenous thrombolysis or endovascular thrombectomy,whether assessed as a dichotomous or ordinal variable.Conclusions Mobile stroke care expedited both intravenous thrombolysis and endovascular thrombectomy.There is an ongoing need to show improved functional outcomes with MSU care.
文摘Objective To investigate the efficacy and safety of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in acute cerebral infarct patients with atrial fibrillation (AF) and the predicting factors of poor prognosis.Methods Totally 162 patients with acute cerebral infarct were treated with rt-PA within 4.5hours from the onset.According to past history and the electrocardiogram,the patients was classified into
文摘The authors report the first case of thrombolysis in a patient already receiving both aspirin and prasugrel following a recent ischemic coronary event. A 55-year-old gentleman was treated for inferior wall myocardial infarction with aspirin, prasugrel and percutaneous angioplasty of right coronary artery. Three days following the procedure he developed acute ischemic stroke due to a left middle cerebral artery infarction with a National Institute of Health Stroke Scale (NIHSS) of 24 and was treated with alteplase. Therapy was interrupted after completion of 29 mg (for a body weight of 65 kg) dose due to oral bleeding. Fifteen minutes post thrombolysis NIHSS was 5 and dropped to zero after 12 h. This report highlights the benefits of alteplase in the context of several relative contraindications like the setting of acute myocardial infarction treated with percutaneous intervention and high NIHSS.
文摘Aim: Stroke is one of the leading causes of death and disability. The proportion of patients receiving recombinant tissue plasminogen activator is low in our country. Biomarkers to identify patients at risk of severe disease, and guide treatment and prognosis would be valuable. This article aims to identify the factors that can independently prognosticate the acute phase of ischemic stroke. Methods: All patients with the first episode of ischemic stroke admitted to the Neurology Department between 1st December 2017 to 31st March 2018 were included in this pilot study. Stroke severity was evaluated using the National Institute of Health Stroke Scale (NIHSS). Patients being admitted within 4.5 h of onset of symptoms were thrombolysed with injection alteplase. For each patient, 4 serum biomarkers (D-dimer, fibrinogen, C-reactive pro-tein and neuron specific enolase) were evaluated at admission and 24 h later. Discharged patients were assessed on an outpatient basis using the modified Rankin scale. The study primarily aimed to identify the factors predicting the severity and outcome of stroke, and to evaluate the effect of thrombolysis on the outcome. The secondary aim was to evaluate the role of biomarkers to predict the unfavorable outcome and the chance of post thrombolysis hemor-rhage. Results: Out of 30 patients included in the study, 10 had NIHSS 0-4, 12 had NIHSS 5-15 and 8 had NIHSS 16-42. Sixteen patients had unfavorable outcome (mRS score ≥ 2), and 5 patients expired. Old age, history of diabetes, CHADS2 score ≥ 2, and total anterior circulation stroke (TACS) independently affected stroke severity, whereas lowejection fraction < 35%, and TACS, independently predicted unfavorable outcome and mortality. High mean arte-rial blood pressure (MABP) and capillary blood glucose (CBG) at admission were significant predictors of stroke severity, unfavorable outcome, and mortality. Out of 10 thrombolysed patients, two had mRS score ≥ 2 and 3 had the post-thrombolysis hemorrhage. Thrombolysis significantly reduced the incidence of the unfavorable outcome, but did not significantly affect death. All the biomarker levels at admission were significantly higher among patients with severe stroke and those who subsequently had an unfavorable outcome. D-dimer levels significantly increased and fibrinogen level significantly decreased following thrombolysis. Higher MABP, CBG, and fibrinogen levels at ad-mission predicted significantly higher chance to develop hemorrhagic complications post thrombolysis. Conclusion: Low ejection fraction, occurrence of TACS and the higher levels of the biomarkers under study pre-dicted poor outcome. Higher mean CBG and MABP and raised fibrinogen levels predicted higher chance of post-thrombolysis hemorrhage.
