| Early recurrent ischemic stroke complicating intravenous thrombolysis for stroke: incidence and association with atrial fibrillation. | |
| | |
MedLine Citation:
|
PMID: 20705933 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND AND PURPOSE: Mechanisms of early neurologic deterioration after treatment with intravenous, recombinant, tissue-type plasminogen activator (IV rt-PA) include symptomatic intracerebral hemorrhage (SICH) and early recurrent ischemic stroke. We observed a number of cases of acute deterioration due to recurrent ischemic events. METHODS: We undertook a single-center, retrospective analysis of consecutive acute stroke patients treated with IV rt-PA between January 2006 and December 2008 to define the incidence of early neurologic deterioration (>or=4-point drop on the National Institutes of Health Stroke Scale within 72 hours) and its mechanism. Deterioration was attributed to SICH when associated with a PH1 or PH2 hemorrhage on postdeterioration computed tomography scans, to recurrent ischemic stroke when there was clinical and radiologic evidence of a new territorial infarction or new vessel occlusion, and otherwise to evolution of the incident stroke. RESULTS: Of 228 consecutive IV rt-PA-treated patients, 34 (15%) developed early neurologic deterioration, 18 (8%) secondary to incident strokes 10 (4.4%) due to SICH, and 6 (2.6%) due to early recurrent ischemic events, which were significantly associated with atrial fibrillation (present in 5 of 6 patients; 4 paroxysmal, 1 permanent). In 4 patients, sudden clinical deterioration developed during or shortly after IV rt-PA infusion, and in 2, deterioration developed 3 days later. All died 2 days to 2 weeks later. The single case without atrial fibrillation had a recurrent, contralateral, middle cerebral artery stroke during IV rt-PA infusion and multiple high-signal emboli detected by transcranial Doppler. Early recurrent ischemic stroke accounted for 5 of 12 (42%) cases of early neurologic deterioration in patients with atrial fibrillation. CONCLUSIONS: In this single-center series, the incidence of early recurrent ischemic stroke after IV rt-PA was 2.6% and was associated with previous atrial fibrillation. |
| | |
Authors:
|
Mostafa Awadh; Niall MacDougall; Celestine Santosh; Evelyn Teasdale; Tracey Baird; Keith W Muir |
Related Documents
:
|
6075463 - Carotid artery occlusive disease. clinical considerations in surgical revascularization. 20829413 - A novel approach to ambulatory monitoring: investigation into the quantity and control ... 19801023 - Comparison of bleeding complications with omega-3 fatty acids + aspirin + clopidogrel--... |
Publication Detail:
|
Type: Journal Article Date: 2010-08-12 |
Journal Detail:
|
Title: Stroke; a journal of cerebral circulation Volume: 41 ISSN: 1524-4628 ISO Abbreviation: Stroke Publication Date: 2010 Sep |
Date Detail:
|
Created Date: 2010-08-31 Completed Date: 2010-09-22 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 0235266 Medline TA: Stroke Country: United States |
Other Details:
|
Languages: eng Pagination: 1990-5 Citation Subset: IM |
Affiliation:
|
Division of Clinical Neurosciences, University of Glasgow, Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Aged Aged, 80 and over Atrial Fibrillation / complications*, epidemiology* Brain Ischemia / complications*, epidemiology* Female Fibrinolytic Agents / therapeutic use Humans Incidence Logistic Models Male Middle Aged Recurrence Retrospective Studies Stroke / complications*, drug therapy* Tissue Plasminogen Activator / therapeutic use* Treatment Outcome |
| Chemical | |
Reg. No./Substance:
|
0/Fibrinolytic Agents; EC 3.4.21.68/Tissue Plasminogen Activator |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Predictors of the Subarachnoid Hemorrhage of a Negative CT Scan.
Next Document: Re: Immediate Risk of Suicide and Cardiovascular Death After a Prostate Cancer Diagnosis: Cohort Stu...