Emergency surgical intervention in a patient with delayed diagnosis of aortic dissection presenting with acute ischemic stroke and undergoing thrombolytic therapy

Chua, Chai Hock; Lien, Li Ming; Lin, Chia Hsun; Hung, Chi Ren

doi:10.1016/j.jtcvs.2005.06.023

Cited by 28 publications

(16 citation statements)

References 4 publications

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“…A Medline search of the English-language literature using the MeSH terms "dissecting aneurysm" and "thrombolytic therapy" or the terms "aortic dissection" and "thrombolysis" resulted in 6 reports of patients with acute aortic dissection presenting as ischemic cerebral infarction who were considered for thrombolytic therapy or inadvertently received such therapy (Table 1). [7][8][9][10][11][12] Typical risk factors for ischemic infarction, 13 including age and hypertension, were present in five of the six patients reported, [7][8][9][10][11] as well as in the present case. Undoubtedly, the presence of these traditional risk factors made it difficult for the clinician to suspect the correct diagnosis in these cases.…”

Section: Discussionsupporting

confidence: 62%

Ischemic Stroke, Aortic Dissection, and Thrombolytic Therapy—the Importance of Basic Clinical Skills

2007

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Section: Discussionsupporting

confidence: 62%

Ischemic Stroke, Aortic Dissection, and Thrombolytic Therapy—the Importance of Basic Clinical Skills

2007

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“…However, it is feared that in patients with ascending aortic arch dissection, intravenous alteplase could induce rupture of the dissection. In some cases of acute aortic dissection, neurological deficits could be observed, 414 especially if the dissection extends into the cervical internal carotid artery. A paucity of cases reported in the literature deal with this issue; the majority favor avoiding the use intravenous alteplase in the setting of aortic dissection.…”

Section: Demaerschalk Et Al Intravenous Alteplase In Acute Ischemic Smentioning

confidence: 99%

“…A paucity of cases reported in the literature deal with this issue; the majority favor avoiding the use intravenous alteplase in the setting of aortic dissection. [415][416][417] When intravenous alteplase was administered in the setting of acute stroke, some patients developed symptoms such as flank pain, 414 chest and ear pain, 418 or a cold extremity with no palpable pulse. 419 Further imaging revealed aortic dissection in each case.…”

Section: Demaerschalk Et Al Intravenous Alteplase In Acute Ischemic Smentioning

confidence: 99%

Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

Demaerschalk¹,

Kleindorfer²,

Adeoye³

et al. 2016

Stroke

564

237

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Purpose-To critically review and evaluate the science behind individual eligibility criteria (indication/inclusion and contraindications/exclusion criteria) for intravenous recombinant tissue-type plasminogen activator (alteplase) treatment in acute ischemic stroke. This will allow us to better inform stroke providers of quantitative and qualitative risks associated with alteplase administration under selected commonly and uncommonly encountered clinical circumstances and to identify future research priorities concerning these eligibility criteria, which could potentially expand the safe and judicious use of alteplase and improve outcomes after stroke. Methods-Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge and, when appropriate, formulated recommendations using standard American Heart Association criteria. All members of the writing group had the opportunity to comment on and approved the final version of this document. The document underwent extensive American Heart Association internal peer review, Stroke The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on September 24, 2015, and the American Heart Association Executive Committee on October 5, 2015. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@ wolterskluwer.com.The online-only Data Supplement, which contains literature search strategies and Figures A, B, and C, is available with this article at http://circ. ahajournals.org/lookup/suppl/doi:10.1161/STR.0000000000000086/-/DC1.The American Heart Association requests that this document be cited as follows: Demaerschalk BM, Kleindorfer DO, Adeoye OM, Demchuk AM, Fugate JE, Grotta JC, Khalessi AA, Levy EI, Palesch YY, Prabhakaran S, Saposnik G, Saver JL, Smith EE; on behalf of the American Heart Association Stroke Council and Council on Epidemiology and Prevention. Scientific rational...

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“…[61][62][63] Aortic Dissection or Aneurysm Three patients with aortic dissection received thrombolysis for stroke, two IVT 64,65 and one IAT 66 ; one experienced an aortic rupture and required graft surgery. 65 No data were found on patients who received IVT for stroke and died in which the necropsy revealed an amyloid angiopathy.…”

Section: Recent Myocardial Infarct or Pericarditismentioning

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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Emergency surgical intervention in a patient with delayed diagnosis of aortic dissection presenting with acute ischemic stroke and undergoing thrombolytic therapy

Cited by 28 publications

References 4 publications

Ischemic Stroke, Aortic Dissection, and Thrombolytic Therapy—the Importance of Basic Clinical Skills

Ischemic Stroke, Aortic Dissection, and Thrombolytic Therapy—the Importance of Basic Clinical Skills

Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

Hemorrhagic Complications After Off-Label Thrombolysis for Ischemic Stroke

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