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Wang Y, Sun H, Wang GN, Zhang XM, Zhang JS. Orolingual angioedema during thrombolysis in acute ischemic stroke: A case report. World J Emerg Med 2022; 13:71-73. [PMID: 35003421 PMCID: PMC8677918 DOI: 10.5847/wjem.j.1920-8642.2022.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 10/26/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Yao Wang
- Department of Emergency Medicine, Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Hao Sun
- Department of Emergency Medicine, Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Gan-nan Wang
- Department of Emergency Medicine, Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xiao-min Zhang
- Department of Emergency Medicine, Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jin-song Zhang
- Department of Emergency Medicine, Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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Zhang S, Gao L, Wo X, Wang Z. Clinical observation of mild hypothermia combined with intravenous thrombolysis in treating patients with acute cerebral infarction. Pak J Med Sci 2021; 37:1813-1818. [PMID: 34912400 PMCID: PMC8613037 DOI: 10.12669/pjms.37.7.4499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/08/2021] [Accepted: 06/29/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives: To investigate the clinical effect of mild hypothermia combined with intravenous thrombolysis in the treatment of acute cerebral infarction. Methods: Eighty-eight patients with acute cerebral infarction in Binzhou People’s Hospital between May 2018 and August 2019 were randomly selected and divided into a control group and an observation group according to the random number table method, with 44 patients in each group. The control group was given intravenous thrombolysis; the observation group was treated with mild hypothermia (30-35°C) in addition to intravenous thrombolytic thrombolysis. The clinical efficacy, incidence of complications, oxidative stress indexes, inflammatory factor level, neurological function, and mental state of the two groups before and after treatment were compared. Results: The clinical efficacy of the observation group was significantly better than that of the control group, and the difference was statistically significant (P<0.05). There was no significant difference in the levels of oxidative stress indexes and inflammatory factors between the two groups before treatment (P<0.05). After treatment, the levels of oxidative stress indexes and inflammatory factors of the two groups significantly improved, and the improvement of the observation group was better than that of the control group; the differences were statistically significant (P<0.05). There was no significant difference in the neurological function and mental state between the two groups before treatment (P<0.05). After treatment, the neurological function and mental state of the two groups significantly improved, and the improvement of the observation group was better than that of the control group; the differences were statistically significant (P<0.05). There was no significant difference in the incidence of complications and mortality between the two groups (P>0.05). Conclusion: Thrombolytic therapy combined with mild hypothermia has a good efficacy in the treatment of acute cerebral infarction. The therapy can improve the neurological function of patients with acute cerebral infarction by significantly improving the oxidative stress index and relieving the inflammatory reaction. Its efficacy is better than single thrombolytic therapy.
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Affiliation(s)
- Shaojie Zhang
- Shaojie Zhang, Department of Neurology, Binzhou People's Hospital, Shandong 256610, China
| | - Lilin Gao
- Lilin Gao, Department of Neurology, Binzhou People's Hospital, Shandong 256610, China
| | - Xuewen Wo
- Xuewen Wo, Department of Neurology, Binzhou People's Hospital, Shandong 256610, China
| | - Zhonggong Wang
- Zhonggong Wang, Department of Neurology, Binzhou People's Hospital, Shandong 256610, China
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Zhong TT, Wang G, Wang XQ, Kong WD, Li XY, Xue Q, Zou YA. Serum calcium, albumin, globulin and matrix metalloproteinase-9 levels in acute cerebral infarction patients. World J Clin Cases 2021; 9:9070-9076. [PMID: 34786389 PMCID: PMC8567529 DOI: 10.12998/wjcc.v9.i30.9070] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/09/2021] [Accepted: 08/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hemorrhagic transformation (HT) is a common complication in patients with cerebral infarction. However, its pathogenesis is poorly understood. The knowledge of factors that may increase risk for HT may help in improving the safety of thrombolytic therapy.
AIM To investigate the predictive value of serum calcium, albumin, globulin and matrix metalloproteinase-9 (MMP-9) levels for HT after intravenous thrombolysis (IVT) in patients with acute cerebral infarction.
METHODS Five hundred patients with acute cerebral infarction who received IVT with alteplase within 4.5 h after the onset of disease between January 2018 and January 2021 at our hospital were selected as the study subjects. They were divided into groups based on computed tomography scan results of the brain made within 36 h after thrombolysis. Forty patients with HT were enrolled in an observation group and 460 patients without HT were enrolled in a control group. Serum calcium, albumin, globulin and MMP-9 levels were compared between the two groups. Regression analysis was used to discuss the relationship between these indices and HT.
RESULTS The previous history of hypertension, diabetes, atrial fibrillation, cerebrovascular diseases, smoking and alcohol intake were not associated with HT after IVT in patients with acute cerebral infarction (all P > 0.05). The National Institutes of Health stroke scale (NHISS) score was associated with HT after IVT in patients with acute cerebral infarction (P < 0.05). The serum calcium and albumin levels were lower in the observation group than in the control group (all P < 0.05). The levels of globulin and MMP-9 were significantly higher in the observation group than in the control group (all P < 0.05). Logistic regression analysis showed that NHISS score, serum calcium, albumin, globulins and MMP-9 were independent factors influencing the occurrence of HT following IVT in patients with cerebral infarction (P < 0.05).
CONCLUSION Serum calcium, albumin, globulin and MMP-9 levels are risk factors for HT after IVT in patients with acute cerebral infarction. Moreover, NHISS score can be used as a predictor of post-thrombolytic HT.
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Affiliation(s)
- Ting-Ting Zhong
- Department of Neurology, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei Province, China
| | - Gang Wang
- Department of Neurology, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei Province, China
| | - Xiao-Qin Wang
- Department of Neurology, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei Province, China
| | - Wei-Dan Kong
- Department of Neurology, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei Province, China
| | - Xiao-Yu Li
- Department of Neurology, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei Province, China
| | - Qian Xue
- Department of Neurology, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei Province, China
| | - Yu-An Zou
- Department of Neurology, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei Province, China
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Adverse consequences of immediate thrombolysis-related complications: a multi-centre registry-based cohort study of acute stroke. J Thromb Thrombolysis 2021; 53:218-227. [PMID: 34255266 PMCID: PMC8791861 DOI: 10.1007/s11239-021-02523-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2021] [Indexed: 10/27/2022]
Abstract
Complications following thrombolysis for stroke are well documented, and mostly concentrated on haemorrhage. However, the consequences of patients who experience any immediate thrombolysis-related complications (TRC) compared to patients without immediate TRC have not been examined. Prospectively collected data from the Sentinel Stroke National Audit Programme were analysed. Thrombolysis was performed in 451 patients (52.1% men; 75.3 years ± 13.2) admitted with acute ischaemic stroke (AIS) in four UK centres between 2014 and 2016. Adverse consequences following immediate TRC were assessed using logistic regression, adjusted for age, sex and co-morbidities. Twenty-nine patients (6.4%) acquired immediate TRC. Compared to patients without, individuals with immediate TRC had greater adjusted risks of: moderately-severe or severe stroke (National Institutes of Health for Stroke Scale score ≥ 16) at 24-h (5.7% vs 24.7%, OR 3.9, 95% CI 1.4-11.1); worst level of consciousness (LOC) in the first 7 days (score ≥ 1; 25.0 vs 60.7, OR 4.6, 95% CI 2.1-10.2); urinary tract infection or pneumonia within 7-days of admission (13.5% vs 39.3%, OR 3.2, 95% CI 1.3-7.7); length of stay (LOS) on hyperacute stroke unit (HASU) ≥ 2 weeks (34.7% vs 66.7%, OR 5.2, 95% CI 1.5-18.4); mortality (13.0% vs 41.4%, OR 3.7, 95% CI 1.6-8.4); moderately-severe or severe disability (modified Rankin Scale score ≥ 4) at discharge (26.8% vs 65.5%, OR 4.7, 95% CI 2.1-10.9); palliative care by discharge date (5.1% vs 24.1%, OR 5.1, 95% CI 1.7-15.7). The median LOS on the HASU was longer (7 days vs 30 days, Kruskal-Wallis test: χ2 = 8.9, p = 0.003) while stroke severity did not improve (NIHSS score at 24-h post-thrombolysis minus NIHSS score at arrival = - 4 vs 0, χ2 = 24.3, p < 0.001). In conclusion, the risk of nosocomial infections, worsening of stroke severity, longer HASU stay, disability and death is increased following immediate TRC. The management of patients following immediate TRC is more complex than previously thought and such complexity needs to be considered when planning an increased thrombolysis service.
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Mas-Serrano M, García-Pastor A, Iglesias-Mohedano AM, Díaz-Otero F, Vázquez-Alén P, Fernández-Bullido Y, Vales-Montero M, Amaya-Pascasio L, Portela-Sánchez S, Cátedra-Caramé C, Gil-Núñez AC. Related factors with orolingual angioedema after intravenous alteplase in acute ischemic stroke: results from a single-center cohort and meta-analysis. Neurol Sci 2021; 43:441-452. [PMID: 33907941 DOI: 10.1007/s10072-021-05279-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/20/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Orolingual angioedema (OA) after intravenous thrombolysis (IVT) with alteplase in acute stroke can be a life-threatening complication. Our aim was to describe its incidence, clinical features, and related factors. PATIENTS AND METHODS We analyzed a single-center cohort of stroke patients treated with IVT in an 8-year period. We compared patients with (OA+) and without OA (OA-). A meta-analysis of previous studies was performed to identify factors related with OA. RESULTS OA occurred in 7 out of 512 patients (1.37%; 95% CI 0.86-1.88%). Previous hypertension, diabetes, and treatment with ACE inhibitors were more frequent in OA+ compared to OA- patients (100% vs 58%, p = 0.045; 71.4% vs 21.8%, p = 0.008; and 71.4% vs. 16.6%, p = 0.002). Three out of 4 cases with unilateral OA had a contralateral insular infarct. The meta-analysis included 13 studies: 5720 stroke patients treated with IVT and 209 cases of OA. Factors related with OA were ACE inhibitor treatment (RR 5.33 [95% CI 3.07-9.26]) female sex (RR 1.94 [95% CI 1.24-3.03]), hypertension (RR 2.64 [95% CI 1.79-3.90]), diabetes (RR 1.60 [95% CI 1.16-2.21]), and dyslipidemia (RR 1.46 [95% CI 1.00-2.12]). The effect of insular infarct was inconclusive: positive when considering complete infarcts (RR 1.97 [95% CI 1.18-3.29]) and absent when partial infarcts were also included. CONCLUSIONS OA occurred in 1.37% of the IVT-treated stroke patients. Previous treatment with ACE inhibitors, hypertension, diabetes, dyslipidemia, and female sex were associated with OA. The effect of insular infarct needs to be clarified in further studies.
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Affiliation(s)
- Miguel Mas-Serrano
- Stroke Centre - Department of Vascular Neurology, Hospital General Universitario Gregorio Marañón, Calle del Doctor Esquerdo, 46, 2800, Madrid, Spain
| | - Andrés García-Pastor
- Stroke Centre - Department of Vascular Neurology, Hospital General Universitario Gregorio Marañón, Calle del Doctor Esquerdo, 46, 2800, Madrid, Spain.
| | - Ana María Iglesias-Mohedano
- Stroke Centre - Department of Vascular Neurology, Hospital General Universitario Gregorio Marañón, Calle del Doctor Esquerdo, 46, 2800, Madrid, Spain
| | - Fernando Díaz-Otero
- Stroke Centre - Department of Vascular Neurology, Hospital General Universitario Gregorio Marañón, Calle del Doctor Esquerdo, 46, 2800, Madrid, Spain
| | - Pilar Vázquez-Alén
- Stroke Centre - Department of Vascular Neurology, Hospital General Universitario Gregorio Marañón, Calle del Doctor Esquerdo, 46, 2800, Madrid, Spain
| | - Yolanda Fernández-Bullido
- Stroke Centre - Department of Vascular Neurology, Hospital General Universitario Gregorio Marañón, Calle del Doctor Esquerdo, 46, 2800, Madrid, Spain
| | - Marta Vales-Montero
- Stroke Centre - Department of Vascular Neurology, Hospital General Universitario Gregorio Marañón, Calle del Doctor Esquerdo, 46, 2800, Madrid, Spain
| | - Laura Amaya-Pascasio
- Stroke Centre - Department of Vascular Neurology, Hospital General Universitario Gregorio Marañón, Calle del Doctor Esquerdo, 46, 2800, Madrid, Spain
| | - Sofía Portela-Sánchez
- Stroke Centre - Department of Vascular Neurology, Hospital General Universitario Gregorio Marañón, Calle del Doctor Esquerdo, 46, 2800, Madrid, Spain
| | - Carlos Cátedra-Caramé
- Stroke Centre - Department of Vascular Neurology, Hospital General Universitario Gregorio Marañón, Calle del Doctor Esquerdo, 46, 2800, Madrid, Spain
| | - Antonio Carmelo Gil-Núñez
- Stroke Centre - Department of Vascular Neurology, Hospital General Universitario Gregorio Marañón, Calle del Doctor Esquerdo, 46, 2800, Madrid, Spain
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A Case of Oropharyngeal Angioedema Following Intravenous Recombinant Tissue Plasminogen Activator (rt-PA) and Mechanical Thrombectomy. DRUG SAFETY - CASE REPORTS 2019; 6:10. [PMID: 31605241 PMCID: PMC6789049 DOI: 10.1007/s40800-019-0104-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
A 72-year-old housewife presented with ischemic cerebrovascular stroke. Intravenous thrombolysis using recombinant tissue plasminogen activator (rt-PA) followed by mechanical thrombectomy under general anesthesia were attempted. The patient developed stridor and tongue swelling, in addition to hypotension and bradycardia, 60 min after completion of the rt-PA infusion. The airway was intubated, and intramuscular adrenaline, together with intravenous hydrocortisone and diphenhydramine, were administered. On the second day, the tongue edema subsided, and the cuff leak test was negative. However, extubation was not attempted due to the development of brain edema. A tracheostomy was later performed, and the patient was weaned off mechanical ventilation.
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