Cerebral aneurysm rupture after r-TPA thrombolysis for acute myocardial infarction

Lagares, Alfonso; Gómez, P.A.; Lobato, R.D.; Alén, J.F.; Campollo, J.; Benito‐León, Julián

doi:10.1016/s0090-3019(99)00147-0

Cited by 31 publications

(29 citation statements)

References 14 publications

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“…Although thrombolysis may be relatively safe for unruptured cerebral aneurysm, or incidental aneurysm, a patient suffered rupture of an anterior communicating artery aneurysm during tPA thrombolysis for acute myocardial infarction. 3) Our Case 1 suffered massive rebleeding and subsequent sudden deterioration. A total length of 10 cm GDCs was placed into the 3-mm diameter ACA aneurysm.…”

Section: Sismentioning

confidence: 73%

Ruptured Cerebral Aneurysm Complicated With Rebleeding Following Thrombolysis During Endovascular Embolization-Two Case Reports-

Hayashi

Takahata

Kitagawa

2007

Neurol. Med. Chir.(Tokyo)

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A 68-year-old woman and a 42-year-old woman presented with subarachnoid hemorrhage due to rupture of cerebral aneurysm. Both patients were treated with endovascular coil embolization. Thromboembolic complications occurred during the procedure and local thrombolysis was performed for recanalization. One patient developed massive rebleeding immediately after the procedure and the other suffered minor hemorrhage adjacent to the embolized aneurysm 2 days later. Local thrombolysis during treatment of ruptured aneurysm by coil embolization carries a significant risk of rebleeding. Prevention of thromboembolic complication by adequate heparinization is important.

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Section: Sismentioning

confidence: 73%

Ruptured Cerebral Aneurysm Complicated With Rebleeding Following Thrombolysis During Endovascular Embolization-Two Case Reports-

Hayashi

Takahata

Kitagawa

2007

Neurol. Med. Chir.(Tokyo)

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“…The AHA commission noted that the presence of aneurysms with a diameter less than 10 mm on CT angiography would not change the IV tPA decision and that larger aneurysms could not be assured of safety and more experience was needed (7). In the literature, aneurysmal rupture (mortal) after systemic tPA has been published in at least 3 non-stroke cases, one combined with heparin for AMI and a 100-mg dose (71,72,73). There is no such case report in the dose used for stroke.…”

Section: Question: What Is the Importance Of Early Infarction Signs Imentioning

confidence: 99%

Intravenous Thrombolytic Therapy in Acute Stroke: Problems and Solutions

Topçuoğlu¹,

Arsava²,

Özdemi̇r³

et al. 2017

tnd

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162Use of intravenous tissue plasminogen activator (tPA) is one of the key elements of acute ischemic stroke management. Its use has not become widespread, and has faced significant problems in our country for more than a quarter of a century most probably due to many unanswered questions about issues related with daily practice. However, recent developments, which adequately focused and found solutions for most of these problems and questions, have led to a major change of point of view and understanding of the hyperacute management of stroke. This article, in the light of the relevant literature, discusses and provides clear recommendations for questions directed by neurologists practicing in Turkey mainly about typical neurologic issues faced in the setting of tPA use for acute stroke.Keywords: Stroke, thrombectomy, contraindication, avoidance, training Akut iskemik inme tedavisinin kritik elementlerinin başında gelen intravenöz doku plazminojen aktivatörü (tPA) kullanımının yirmi yılı aşkın süre içinde ülkemizde yeterince yaygınlaşamamasının başta gelen nedenlerinden biri, kullanımına dair birçok sorunun yanıtsız kalmasıdır. Ancak, son gelişmeler ile bu soruların pek çoğuna yeterli açıklamanın getirilebilmiş olması önemli bir anlayış değişikliğine yol açmaktadır. Bu makalede akut inmede tPA tedavisi ile ilgili uzmanlarımızın yönelttiği birincil olarak nörolojik sorulara ilişkin yanıt ve açıklamalar mevcut literatür ışığında etraflıca ele alınmış ve herbiri için net tavsiyelerde bulunulmuştur.Anahtar Kelimeler: Strok, trombektomi, kontrendikasyon, kaçınma, eğitim Abstract Öz

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“…SICH occurred in 3 patients treated with IAT (2 with UK, one with tPA), with 2 being subarachnoid hemorrhages. 16 -18 Thrombolysis for nonstroke uses in patients with intracranial aneurysms has been reported in 4 patients: 3 patients with intracranial aneurysms (coiled, clipped, and untreated, respectively) received IVT for MI 21,22 ; the patient with an untreated aneurysm experienced a subarachnoid hemorrhage. 21 The fourth patient with a coiled aneurysm was safely treated for PE with local thrombolysis with tPA and thrombus fragmentation.…”

Section: Sich After Off-label Thrombolysis (Tables 1 and 2)mentioning

confidence: 99%

“…16 -18 Thrombolysis for nonstroke uses in patients with intracranial aneurysms has been reported in 4 patients: 3 patients with intracranial aneurysms (coiled, clipped, and untreated, respectively) received IVT for MI 21,22 ; the patient with an untreated aneurysm experienced a subarachnoid hemorrhage. 21 The fourth patient with a coiled aneurysm was safely treated for PE with local thrombolysis with tPA and thrombus fragmentation. 23 Concerning thrombolysis in patients with intracranial arteriovenous malformations, 2 patients were found; IAT with tPA for ischemic stroke was safely used for a middle cerebral artery embolism during diagnostic angiography 24 and IVT for PE was safely given to a patient with an unruptured arteriovenous malformation.…”

Section: Sich After Off-label Thrombolysis (Tables 1 and 2)mentioning

confidence: 99%

Hemorrhagic Complications After Off-Label Thrombolysis for Ischemic Stroke

Aleu

Mellado²,

Lichy³

et al. 2007

Stroke

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Background and Purpose-Only 2% to 4% of patients with acute ischemic stroke receive thrombolytic therapy resulting from the current strict inclusion criteria among other issues. Safety of intravenous and intraarterial thrombolysis in off-label situations is controversially discussed. We sought to review the reports on such patients regarding intra-and extracranial hemorrhage. Summary of Review-A MEDLINE search for off-label uses of thrombolysis revealed reports on 273 patients treated with intraarterial or intravenous thrombolysis for ischemic stroke. Symptomatic intracranial hemorrhage occurred in 19 of 273 patients (6.95%) and extracranial hemorrhage in 17 of 273 (6.22%). Conclusions-These data suggest that the overall bleeding risk in off-label thrombolysis may not be as high as presumed.However, the small number of patients in each group and the likely underreporting of worse outcomes preclude drawing any conclusion as to specific treatment recommendations. Selected patients might benefit, however, from thrombolysis in situations not currently considered in the inclusion criteria. To obtain a meaningful database, a registry for off-label thrombolysis should be created. (Stroke. 2007;38:417-422.)

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Cerebral aneurysm rupture after r-TPA thrombolysis for acute myocardial infarction

Cited by 31 publications

References 14 publications

Ruptured Cerebral Aneurysm Complicated With Rebleeding Following Thrombolysis During Endovascular Embolization-Two Case Reports-

Ruptured Cerebral Aneurysm Complicated With Rebleeding Following Thrombolysis During Endovascular Embolization-Two Case Reports-

Intravenous Thrombolytic Therapy in Acute Stroke: Problems and Solutions

Hemorrhagic Complications After Off-Label Thrombolysis for Ischemic Stroke

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