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Titolo:
Arterial status after intravenous TPA therapy for ischaemic stroke. A needfor further interventions
Autore:
Christou, I; Burgin, WS; Alexandrov, AV; Grotta, JC;
Indirizzi:
Univ Texas, Houston Med Sch, Ctr Noninvas Brain Perfus Studies, Stroke Treatment Team, Houston, TX 77030 USA Univ Texas Houston TX USA 77030 oke Treatment Team, Houston, TX 77030 USA
Titolo Testata:
INTERNATIONAL ANGIOLOGY
fascicolo: 3, volume: 20, anno: 2001,
pagine: 208 - 213
SICI:
0392-9590(200109)20:3<208:ASAITT>2.0.ZU;2-R
Fonte:
ISI
Lingua:
ENG
Soggetto:
ACUTE MYOCARDIAL-INFARCTION; INTERNAL CAROTID-ARTERY; TRANSCRANIAL DOPPLER; ISCHEMIC STROKE; STENOSIS; THROMBOLYSIS; ANGIOPLASTY; TRIAL; OCCLUSION; ABCIXIMAB;
Keywords:
brain ischemia, therapy; ultrasonography, Doppler, transcranial; tissue plasminogen activator; cerebrovascular accident, therapy;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
19
Recensione:
Indirizzi per estratti:
Indirizzo: Christou, I 18-20 Spetson St, Athens 15344, Greece 18-20 Spetson St Athens Greece 15344 t, Athens 15344, Greece
Citazione:
I. Christou et al., "Arterial status after intravenous TPA therapy for ischaemic stroke. A needfor further interventions", INT ANGIOL, 20(3), 2001, pp. 208-213

Abstract

Background. Intravenous tissue plasminogen activator (TPA) is an approved therapy for acute ischaemic stroke in the United States. We aimed to noninvasively monitor the therapy to determine arterial recanalisation and persisting vascular abnormalities. Methods. We prospectively studied consecutive patients with symptoms of ischaemic stroke who received intravenous TPA and were monitored by 2 MHz transcranial Doppler (TCD) to determine occlusion and recanalisation (TIMI grades equivalent). For outcome assessment we used the National Institutes of Health Stroke Scale (NIHSS) score. Results. Sixty patients were studied (age 71 +/- 15 years, pre-TPA NIHSS 18 +/- 6.1, TPA bolus at 141 +/- 68 min after stroke onset). The internal carotid artery (ICA) was occluded in 25%, middle cerebral artery (MCA) in 80%; combined (ICA+MCA) occlusion was found in 19%; and basilar artery (BA) was occluded in 7%. Also, 2% had normal TCD and 8% of patients had no temporal windows. Complete recanalisation on TCD of all insonated arteries was found in 19 patients (32%) at 44 +/- 22 min after a TPA bolus. However, 67% ofMCA, 25% of BA, and all ICA occlusions did not completely recanalise (TIMIgrades 0-2). If flow impairment persisted for more than two hours after a TPA bolus, these patients continued to have significant neurological deficits at 24 hours (15.0 +/- 8.2 vs 6.3 +/- 7.3 NIHSS points, p < 0.001 in non-parametric statistics). High-grade residual stenoses with microembolic signals were seen on TCD in the MCA and BA (n = 3) suggesting continuing clot dissolution. In patients without complete recanalisation (n = 36, or 60%), TCD identified lesions potentially amenable to further interventions. Conclusions. Persisting arterial occlusion after intravenous TPA therapy leads to poor short-term outcome. Noninvasive monitoring of TPA therapy withTCD can identify these high-risk patients for combined interventions such as intra-arterial thrombolysis, mechanical clot disruption, stenting or anticoagulation.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 03/06/20 alle ore 09:46:40