Analysis of the safety and efficacy of intra-arterial thrombolytic therapy in ischemic stroke.

BACKGROUND AND PURPOSE: Intra-arterial thrombolytic therapy (IAT) may be a treatment option for patients with ischemic stroke. We analyzed the safety and efficacy of IAT on the basis of published data. METHODS: We searched computerized databases for studies using IAT in >/=10 patients with ischemic stroke. Some studies had control patients for comparison. Data were collected on age, stroke territory, time to treatment, medication, site of arterial occlusion and recanalization on angiogram, outcomes, and symptomatic intracranial hemorrhage (SICH). RESULTS: The analysis included 27 studies with 852 patients who received IAT and 100 control subjects. There were more favorable outcomes in the IAT than in the control group (41.5% versus 23%, P=0.002), with a lower mortality rate for IAT (IAT, 27.2%; control group, 40%, P=0.004). The IAT group had an odds ratio of 2.4 (95% CI, 1.45 to 3.85) for favorable outcome. SICH was more frequent in the IAT group compared with the control group (9.5% versus 3%, P=0.046). The subgroup of patients receiving a combination of intravenous thrombolytic therapy and IAT had more favorable outcomes than the IAT alone subgroup, but this trend did not reach statistical significance (53.6% versus 41.5%, P=0.1). Among the patients treated with IAT, those who had supratentorial strokes were more likely to have favorable outcomes than those with infratentorial strokes (42.2% versus 25.6%; P=0.001; odds ratio, 2.0; 95% CI, 1.33 to 3.0). CONCLUSIONS: IAT for ischemic stroke appears efficacious but carries an increased risk of SICH. Further prospective studies are needed to prove the safety and efficacy of IAT in stroke.

Aspectos clinicos e laboratoriais de pacientes hospitalizados por coreia reumatica / Clinical and laboratory aspects of patients hospitalized for rheumatic chorea

O trabalho apresenta uma revisao clinica retrospectiva dos prontuarios de 49 pacientes hospitalizados por coreia reumatica. A idade dos pacientes na epoca do dignostico foi, em media, de 12,3 anos. Exluindo-se os movimentos coreicos, a hipotonia constitutiu o sinal neurologico mais frequente. A poliartrite foi o sinal maior mais vezes associado a coreia. Dos exames laboratoriais, o titulo de antiestreptolisina O e a proteina serica estavam alterados em mais da metade dos pacientes. A coreia reumatica, que representa uma das formas de manifestacao da febre reumatica, vinha apresentando reducao da sua incidencia: nos ultimos anos, entretanto, parece ter havido aumento significativo do numero de casos, a semelhanca de relatos da literatura