Assuntos
Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Neurofibromatose 1/diagnóstico , Neurofibromatose 1/genética , Exame Neurológico , Compressão da Medula Espinal/genética , Neoplasias da Medula Espinal/diagnóstico , Neoplasias da Medula Espinal/genética , Adulto , Vértebras Cervicais/patologia , Vértebras Cervicais/cirurgia , Criança , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neurofibromatose 1/patologia , Neurofibromatose 1/cirurgia , Complicações Pós-Operatórias/diagnóstico , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/patologia , Compressão da Medula Espinal/cirurgia , Neoplasias da Medula Espinal/patologia , Neoplasias da Medula Espinal/cirurgiaRESUMO
Intravenous recombinant tissue-type plasminogen activator (rt-PA) therapy is highly recommended to patients who are diagnosed with ischemic stroke within 4.5 hours after the onset while mechanical clot retrieval can be attempted in patients who are not indicated for or cannot effectively receive intravenous rt-PA therapy. In this article, we report early treatment outcomes and discuss the usefulness of mechanical clot retrieval using the Penumbra system (Penumbra Inc., Alameda, California, USA), especially in terms of technical cautions during the procedure and adaptability to elderly and high National Institutes of Health Stroke Scale (NIHSS) patients. We included 7 patients with thromboembolic occlusion. Pretreatment NIHSS score ranged from 11 to 36 (mean: 24.9). All patients achieved good recanalization [thrombolysis in cerebral infarction (TICI) grade 2a or greater] without complications. The NIHSS score at 30 days after the treatment ranged between 0 and 28 (mean: 12.4), and improved more than 10 points in 4 of the 7 patients (57.1%). To obtain good recanalization without complications, selection of suitable reperfusion catheter and careful manipulation of separator prefiguring the occluded distal vessels are essential. The improved NIHSS score at 30 days after the treatment may have led to favorable results, such as an increased participation in available rehabilitation programs and the alleviation of the burden of care. Our findings suggest that the Penumbra system might be effective for treatment in elderly patients or patients with high NIHSS score wherein rt-PA therapy is inadvisable or ineffective in ischemic stroke secondary to large vessel occlusion. Recanalization can improve their quality of life on condition that the procedure is performed successfully without serious complications.
Assuntos
Infarto Cerebral/cirurgia , Trombectomia/instrumentação , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Dano Encefálico Crônico/epidemiologia , Dano Encefálico Crônico/etiologia , Catéteres , Infarto Cerebral/complicações , Infarto Cerebral/reabilitação , Ensaios Clínicos como Assunto , Contraindicações , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroimagem , Qualidade de Vida , Proteínas Recombinantes/uso terapêutico , Reperfusão , Estudos Retrospectivos , Terapia de Salvação , Índice de Gravidade de Doença , Sucção/instrumentação , Sucção/métodos , Trombectomia/métodos , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/uso terapêutico , Resultado do TratamentoRESUMO
A 56-year-old woman with adult idiopathic thrombocytopenic purpura (ITP) diagnosed 17 years previously presented with a fusiform aneurysm manifesting as chronic headache. She had suffered no major hemorrhagic complications, although her platelet counts were between 3.0 x 10(9)/l and 50.0 x 10(9)/l. Magnetic resonance angiography identified a fusiform aneurysm of the right vertebral artery. Endovascular trapping after high-dose gammaglobulin with steroid therapy was performed. The patient received antiplatelet therapy to prevent thromboembolic events. The parent artery and aneurysm were completely occluded with no hemorrhagic complications. Endovascular treatment is considered safe in patients with ITP, although careful periprocedural management of platelet count is required.