Treatment Outcomes of Tissue Plasminogen Activator Infusion for Branch Atheromatous Disease

Deguchi, Ichiro; Hayashi, Takeshi; Kato, Yukio; Nagoya, Harumitsu; Ohe, Yasuko; Fukuoka, Tatsunari; Maruyama, Haruhiko; Horiuchi, Yohsuke; Tanahashi, Norio

doi:10.1016/j.jstrokecerebrovasdis.2012.10.012

Cited by 29 publications

(34 citation statements)

References 8 publications

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“…Early neurological deterioration (END) was reported to occur frequently in BAD-related strokes: the examined studies show an incidence ranging from about 17 to 75% [9,14]. Although mechanisms underlying progression are not completely understood, numerous hypotheses have been formulated, including local thrombosis, local blood-brain barrier disruption, edema, inflammation and excitotoxicity [15] .…”

Section: Clinical Featuresmentioning

confidence: 99%

Branch Atheromatous Disease: A Clinically Meaningful, Yet Unproven Concept

Petrone

Nannoni²,

Bene³

et al. 2015

Cerebrovasc Dis

116

125

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Background: In 1989, Louis Caplan first used the term branch atheromatous disease (BAD) to describe an occlusion or stenosis at the origin of a deep penetrating artery of the brain, associated with a microatheroma or a junctional plaque, and leading to an internal capsule or pontine small infarct. BAD remained an understudied concept for decades. In recent years, the increasing diffusion of high-resolution magnetic resonance imaging (HRMRI) techniques brought new attention to the BAD debate. We have reviewed clinical studies dealing with BAD-related stroke checking whether a univocal definition of BAD existed, as well as to what extent were consistently associated clinical and imaging features reported. Summary: We conducted a search of the available literature published up to October 20, 2015 via PubMed using the following search terms: ‘branch atheromatous disease,' ‘intracranial branch atheromatous disease,' ‘cerebral branch atheromatous disease,' combined with ‘stroke.' Forty-six articles were included. We found discrepant definitions and a large variation among clinical features reported in BAD-related stroke patients: among others, a consistent association between BAD and any specific vascular risk factor profile was not detected. Despite this, early neurological deterioration (END) was consistently reported to occur frequently in such patients, although no clear-cut rate range or specific predictor or mechanism of progression was established. In a majority of the studies reporting imaging data, BAD diagnosis was not based on the selective site or type of arterial walls changes, but was inferred based on the vascular territory, size and/or shape of the ischemic lesion. Following the concept that these changes are seated proximally along the perforator artery, differently from to lipohyalinosis changes located distally, the consequent ischemic lesion was hypothesized to be larger in BAD than in lacunar infarcts. However, across reviewed studies, there was little consistency on the dimensional cutoff used to define BAD-related infarcts. In the last few years, a still limited number of studies using HRMRI techniques is providing preliminary proofs that atheromatous changes causing selective remodeling in the parent vessel and extending through the proximal segment of perforating vessel may subtend BAD. Key Messages: Our literature search showed the lack of a clear-cut definition of BAD, although BAD-related strokes were consistently considered a high risk of END. The use of high-resolution imaging techniques in the assessment of small subcortical strokes may represent the cornerstone in the perspective to better delimiting the boundaries of BAD as a nosological entity.

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Section: Clinical Featuresmentioning

confidence: 99%

Branch Atheromatous Disease: A Clinically Meaningful, Yet Unproven Concept

Petrone

Nannoni²,

Bene³

et al. 2015

Cerebrovasc Dis

116

125

View full text Add to dashboard Cite

show abstract

“…The definition of BAD has not been fully set up yet, but it is universally accepted that BAD is a single subcortical infarction larger than lacunar stoke and lack of severe stenosis (≥50%) of the parent artery that supplies the regions of deep perforators, mainly the lenticulostriate arteries and pontine paramedian arteries ( 22 ). In recent years, the majority of clinical studies have followed the diagnostic criteria ( 12 – 15 ); however, these criteria neither reflect infarcts in the territories of other perforating arteries, nor explain the coexistence of BAD and large artery atherosclerosis. In spite of these shortcomings, no better alternative can be found based on the routine imaging techniques.…”

Section: Discussionmentioning

confidence: 99%

“…Regrettably, a limited number of researches have concentrated on the treatment of BAD due to no international consensus about BAD classifying it as a subtype of stroke in previous etiological classifications. Although the NINDS trial demonstrated that alteplase has similar positive effect on all stroke subgroups ( 25 ), BAD treated with alteplase was found ineffective in recently conducted researches ( 11 , 12 ). The current study indicated that IVT within 4.5 h after stroke onset reduced the incidence of END (unadjusted OR, 3.32; 95% CI, 1.06–10.37) and improved the clinical outcome at 3 months after stroke, with more patients achieving favorable outcome (mRS, 0–1 point; unadjusted OR, 0.25; 95% CI, 0.10–0.62), which is consistent with findings of the NINDS trial ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Intravenous Thrombolysis on Acute Branch Atheromatous Disease: A Retrospective Case–Control Study

Wu¹,

Yang²,

Nie³

et al. 2020

Front. Neurol.

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Background and Objective: Branch atheromatous disease (BAD) is distinctive from large-artery atherosclerosis and small-vessel disease, which is single subcortical infarction caused by the occlusion of perforator's orifice. This study aimed to indicate whether intravenous thrombolysis (IVT) with alteplase could prevent early neurological deterioration (END) and improve functional outcome for patients with BAD within 4.5 h after symptom onset. Methods: We retrospectively analyzed data collected from patients with BAD who were admitted to our hospital from January 2015 to August 2019. To investigate the efficacy and safety of IVT, subjects were classified into alteplase and control groups. A propensity score matching analysis was performed to control substantial heterogeneity of subgroup. The coprimary outcomes were END that is defined as an increase of ≥2 points in the National Institutes of Health Stroke Scale (NIHSS) score within 7 days after stroke, and favorable outcome at 3 months after stroke that defined by a score of 0–1 point on the modified Rankin scale (mRS). Results: A total of 135 patients were eventually enrolled in this study ( n = 51 for the alteplase group and n = 84 for the control group). Additionally, 42 pairs of subjects were successfully matched by propensity score matching. Intravenous alteplase within 4.5 h after stroke onset reduced the incidence of END [unadjusted odds ratio (OR), 3.32; 95% confidence interval (CI), 1.06–10.37] and improved the clinical outcome at 3 months after stroke, with more patients achieving favorable functional prognosis (mRS, 0–1 point; unadjusted OR, 0.25; 95% CI, 0.10–0.62). Patients in the alteplase group were more likely to be independent (mRS, 0–2 points) at 3 months after stroke (unadjusted OR, 0.33; 95% CI, 0.12–0.90). The rate of death or dependence (mRS, ≥4 points) in the alteplase group was also markedly lower than that in the control group (unadjusted OR, 4.06; 95% CI, 1.03–16.02). Conclusion: Our findings indicated that intravenous thrombolysis may be a safe and effective therapy for patients with BAD.

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“…Several studies have reported that rt-PA does not reduce END in BAD patients or enhance 3-month mRS scores. 9,22 In addition, Deguchi et al 11 evaluated eight BAD patients who underwent rt-PA intravenous thrombolysis over a 5-year interval. Six (75%) exhibited improved neurological function within 1 hour after intravenous thrombolysis, but 4 (67%) had worsened neurological function within 24 hours and two (25%) had 3-month mRS scores of 3 to 6.…”

Section: Discussionmentioning

confidence: 99%

Early administration of tirofiban after urokinase-mediated intravenous thrombolysis reduces early neurological deterioration in patients with branch atheromatous disease

et al. 2020

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Objectives To investigate the effects of early administration of tirofiban after intravenous thrombolysis on early neurological deterioration in patients with branch atheromatous disease. Methods We analyzed clinical data from patients with branch atheromatous disease. We enrolled seven cases into the urokinase-only (UO) control group and 10 cases into the urokinase + tirofiban (UT) treatment group. National Institutes of Health Stroke Scale (NIHSS) scores were obtained at admission and on days 3 and 5 after admission. Modified Rankin Scale (mRS) scores were obtained 3 months after admission. Results Significant differences between the UO and UT groups were evident on days 3 and 5 after admission. In the UT group, there was a significant difference between NIHSS scores at admission and on day 5, while there were no significant differences in scores in the UO group. The early neurological deterioration rates were not significantly different between the two groups. However, there were significant differences in these rates at 72 and 120 hours. Both the mRS scores and the prognoses at 3 months differed between the two groups. Conclusion Early administration of tirofiban after urokinase-mediated intravenous thrombolysis reduces early neurological deterioration and improves the long-term prognosis of patients with branch atheromatous disease.

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Treatment Outcomes of Tissue Plasminogen Activator Infusion for Branch Atheromatous Disease

Cited by 29 publications

References 8 publications

Branch Atheromatous Disease: A Clinically Meaningful, Yet Unproven Concept

Branch Atheromatous Disease: A Clinically Meaningful, Yet Unproven Concept

Efficacy and Safety of Intravenous Thrombolysis on Acute Branch Atheromatous Disease: A Retrospective Case–Control Study

Early administration of tirofiban after urokinase-mediated intravenous thrombolysis reduces early neurological deterioration in patients with branch atheromatous disease

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