Thrombolytic Therapy for Acute Stroke in Late Pregnancy With Intra-Arterial Recombinant Tissue Plasminogen Activator

Johnson, David M.; Kramer, David C.; Cohen, Ezra; Rochon, Meredith; Rosner, Mara; Weinberger, Jesse

doi:10.1161/01.str.0000166203.27135.27

Cited by 76 publications

(39 citation statements)

References 16 publications

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“…Of these reports, there have been 3 citing the use of thrombolytics specifically in the setting of acute arterial ischemic stroke. [2][3][4] Two cases reported thrombolytic use in women with first-trimester pregnancies, noted improvement in the patients' stroke symptoms after intervention, and reported the birth of healthy infants at term. However, both cases were complicated by the development of intracerebral hemorrhages after lysis.…”

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confidence: 99%

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Intravenous Recombinant Tissue Plasminogen Activator in a Pregnant Woman With Cardioembolic Stroke

Wiese

Talkad

Mathews

et al. 2006

Stroke

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Background and Purpose-Historically, the use of tissue plasminogen activator (tPA) thrombolysis in pregnancy has been regarded as relatively contraindicated. Underlying this stance has been the concern over the risk of bleeding complications in both mother and child. Summary of Case-We report the successful use of intravenous recombinant tPA (rtPA) thrombolysis in a pregnant woman with acute cardioembolic stroke. Conclusions-The patient improved clinically, did not develop complications after receiving rtPA, and at 37 weeks' gestation, delivered a healthy infant, demonstrating that rtPA thrombolysis may be used safely in pregnant women.

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confidence: 99%

“…In this case, a healthy infant was delivered only 3 days after treatment. 4 Herein we report the successful use of intravenous rtPA thrombolysis, uncomplicated by hemorrhage development, in a woman who was 13 weeks pregnant with acute cardioembolic ischemic stroke secondary to presumed prosthetic mitral valve thrombosis.…”

mentioning

confidence: 99%

Intravenous Recombinant Tissue Plasminogen Activator in a Pregnant Woman With Cardioembolic Stroke

Wiese

Talkad

Mathews

et al. 2006

Stroke

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“…The former is more likely to occur in the 1 st and 3 rd trimester and the latter tends to 18) Review of 102 ischemic strokes in 7 articles summarized the causes of ischemic stroke as: 1) pre-eclampsia and eclampsia (37.3%), 2) cardiac disease (25.5%), 3) coagulopathy (7.8%), and 4) atherothrombotic disease (2.0%). These are very different from the causes in the non-pregnant population.…”

Section: Ischemic Strokementioning

confidence: 99%

“…There have been 6 cases reported of intra-arterial thrombolytic therapy in pregnancy (Table 4). 9,18,24,29) The administered thrombolytic agents were rt-PA in 4 cases and urokinase in 2 cases. Good recovery was obtained in 3 of 6 pregnant patients with intra-arterially administered rt-PA at a dose of 15.5-21 mg.…”

Section: Ischemic Strokementioning

confidence: 99%

Endovascular Treatment in Pregnancy

Ishii

Miyamoto

2013

Neurol. Med. Chir.(Tokyo)

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There is an increased risk of stroke during pregnancy and the puerperium. Decisions should be made immediately upon transfer to each institution, particularly with respect to when and how to treat the patient. This review highlights the feasibility of endovascular treatment in pregnancy. Most of the pharmaceutical agents and therapeutic devices used in clinical practice can be utilized in pregnant patients. Comprehensive information on the benefits and risks of treatment should be explained to the patient and her family, with particular attention to the safety of the mother and fetus. Radiation exposure to the fetus is also a concern; the hazard can be minimized with optimal protection. Several studies have demonstrated that conventional procedures do not cause serious radiation exposure exceeding the threshold of safety to the fetus. Endovascular therapy can be safely performed for the treatment of acute stroke as in non-pregnant patients with adequate attention to pharmaceutical agents and shielding from radiation. In contrast to therapy for acute stroke, preventive endovascular treatment for asymptomatic lesions remains controversial. Several conditions, such as cerebral aneurysms and arteriovenous malformations, are known to bleed more frequently in pregnancy, but whether the benefits of preventive treatment outweigh the associated risks is unknown. The decision for preventive treatment should be carefully made on a case-by-case basis after extensive discussion with the patient.

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“…Stroke is associated with a short window of opportunity for treatment. In order to dissolve the clot, various approaches have been tried, such as the intravenous administration of streptokinase [1][2][3][4][5] or urokinase [6,7], intraarterial administration of urokinase [8,9] or prourokinase [10,11], intravenous administration of tissue plasminogen activator (t-PA) [12][13][14][15][16][17] and intraarterial administration of t-PA [18][19][20]. Recanalization rates and final outcomes in the patients have been slightly improved, but with an increase in the incidence of hemorrhage.…”

Section: Introductionmentioning

confidence: 99%

Preclinical testing of a new clot-retrieving wire device using polyvinyl alcohol hydrogel vascular models

et al. 2006

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Introduction Cerebral embolism is the principal cause of cerebral infarction. Recently, mechanical embolectomy has been proposed as an effective method. We performed a preclinical evaluation of a new mechanical clot-retrieving wire. Methods This clot-retrieving wire consisted of three nitinol loops at the tip of a microguidewire. These three loops could be collapsed into a 0.018-inch wire compatible microcatheter. Each loop was 8 mm long and 3.5 mm wide. For simulation, polyvinyl alcohol (PVA) vascular anatomical models of the human carotid (eight models) and vertebrobasilar (three models) circulation were constructed. A pulsatile flow circulation system was used. Embolic clots were produced using pig blood plasma. The microcatheter and the microguidewire were advanced beyond the clot. The wire was then exchanged for the retrieving wire. The microcatheter was then pulled slightly back to open the loops. The clot was then caught by withdrawal of the system. Once caught, the clot was retrieved to the guiding catheter tip. We investigated the following points: ease of device deployment, clot capture ability, clot removal against blood flow and removal of the clot out of the introducer system. Results A total of 104 procedures were performed in 11 PVA models and evaluated. The drop rate was 19%. We succeeded in partial and total recanalization in 51.0% of the procedures (53/104) within 30 minutes. Conclusion This new clot-retrieving wire could be useful for mechanical clot extraction in stroke.

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Thrombolytic Therapy for Acute Stroke in Late Pregnancy With Intra-Arterial Recombinant Tissue Plasminogen Activator

Cited by 76 publications

References 16 publications

Intravenous Recombinant Tissue Plasminogen Activator in a Pregnant Woman With Cardioembolic Stroke

Intravenous Recombinant Tissue Plasminogen Activator in a Pregnant Woman With Cardioembolic Stroke

Endovascular Treatment in Pregnancy

Preclinical testing of a new clot-retrieving wire device using polyvinyl alcohol hydrogel vascular models

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