Successful intra-arterial thrombolysis beyond the accepted 6-hour time window in two young patients

Autor: Suzan Coster, Lukas C. van Dijk, Theo C.A.M. van Woerkom, Frank E E Treurniet, Hans van Overhagen
Rok vydání: 2009
Předmět:
medicine.medical_specialty
medicine.medical_treatment
Abciximab
Immunoglobulin Fab Fragments
Plasminogen Activators
Young Adult
medicine.artery
Internal medicine
Parietal Lobe
medicine
Humans
Thrombolytic Therapy
cardiovascular diseases
Common carotid artery
Thrombus
Stroke
Urokinase
medicine.diagnostic_test
business.industry
Heparin
Antibodies
Monoclonal
Anticoagulants
Infarction
Middle Cerebral Artery
Thrombolysis
medicine.disease
Antiphospholipid Syndrome
Urokinase-Type Plasminogen Activator
Surgery
Cerebral Angiography
Neurology
Injections
Intra-Arterial
Intracranial Embolism
Tissue Plasminogen Activator
Cardiology
Platelet aggregation inhibitor
Female
Neurology (clinical)
Internal carotid artery
business
Tomography
X-Ray Computed
Magnetic Resonance Angiography
Platelet Aggregation Inhibitors
medicine.drug
Cerebral angiography
Zdroj: Journal of the neurological sciences. 288(1-2)
ISSN: 1878-5883
Popis: Two young women with ischemic stroke successfully underwent intra-arterial thrombolysis (IAT) 10 and 11 h, respectively after stroke onset. A 23-year-old (case 1) and a 22-year-old woman (case 2) who developed severe neurological deficits (NIHSS 20 and 13, respectively) were presented to our hospital 9 h after onset of the symptoms. In case 1 a CT angiography (CTA) revealed an occlusion of the left middle cerebral artery (MCA) and in case 2 CTA showed a large embolus at the left carotid bifurcation, almost entirely occluding the internal carotid artery. We decided to apply IAT beyond the generally accepted 6-hour time window. Case 1 was treated with 2 mg rtPA administered locally in the occluded MCA followed by 70 mg rtPA (1 mg/min) and case 2 was treated with 100,000 IU urokinase in the left common carotid artery followed by 200,000 IU during 2 h and 10 mg abciximab. In case 1 IAT resulted in complete recanalisation of the MCA within 3 h and complete resolution of symptoms in the following six weeks. In case 2 IAT resulted in an initial 50% reduction of the thrombus. After nine days CTA showed complete lysis and the patient had completely recovered. Both patients suffered from Anti-Phospholipid-Syndrome. The results show that IAT may be beneficial to young patients with a severe stroke, even beyond the 6-hour time window.
Databáze: OpenAIRE
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