RESUMO
BACKGROUND AND PURPOSE: The intravenous use of recombinant tissue-type plasminogen activator (rTPA) in acute ischemic stroke has been investigated in three large trials. Limited series have reflected outcome after local intraarterial thrombolysis (LIT) in the cerebral territory. The purpose of this study was to evaluate the safety and efficacy of combined intraarterial/intravenous thrombolysis using rTPA (actilyse) for acute ischemic stroke. METHODS: Forty-five patients with acute onset of severe hemispheric stroke and without signs of major cerebral infarction on early CT scans were randomized by order of admission. Twelve patients were treated with 50 mg actilyse (maximal dose, 0.7 mg/kg); three had occlusion of the internal carotid artery and nine had occlusion of the middle cerebral artery. Thrombolysis was started by LIT and continued intravenously within 6 hours of stroke onset. Outcome, assessed after 1 and 12 months according to the modified Rankin scale (MRS), was considered good (MRS score, 0-3) for patients who were functionally independent and poor (MRS score, 4-5) for those who were dependent or had died. RESULTS: In the thrombolysis group, outcome was good in eight patients at 1 month and in 10 patients at 12 months; in the control group, outcome was good in seven (21%) and 11 (33%) patients, respectively. Of the eight patients with a good outcome after thrombolysis, four had complete and one had partial recanalization. In the control group, the rate of intracerebral hemorrhage was 6%. Mortality at 1 month in the thrombolysis and control groups was 17% and 48%, respectively. CONCLUSIONS: Combined intraarterial/intravenous thrombolysis with low-dose rTPA may be a safe and effective treatment for acute ischemic stroke within 6 hours in carefully selected patients.
Assuntos
Isquemia Encefálica/tratamento farmacológico , Fibrinolíticos/administração & dosagem , Ativadores de Plasminogênio/administração & dosagem , Acidente Vascular Cerebral/tratamento farmacológico , Ativador de Plasminogênio Tecidual/administração & dosagem , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/mortalidade , Angiografia Cerebral , Hemorragia Cerebral/induzido quimicamente , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Injeções Intra-Arteriais , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Ativadores de Plasminogênio/efeitos adversos , Ativadores de Plasminogênio/uso terapêutico , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/uso terapêutico , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/mortalidade , Ativador de Plasminogênio Tecidual/efeitos adversos , Ativador de Plasminogênio Tecidual/uso terapêuticoRESUMO
The increasing incidence of stroke is frequently maintained by the processes narrowing precerebral and cerebral arteries. That is why the surgical treatment of cerebrovascular disorders has increasingly included percutaneous transluminal angioplasty. However, the influence of transluminal angioplasty on the biomechanical properties of arterial wall have not been assessed so far. The cylindrical segments of left and right internal carotid artery, middle cerebral artery, anterior cerebral artery, vertebral artery, basilar artery and posterior cerebral artery were taken from 40 autopsy subjects aged from 20 to 75 who had no systemic lesions with the exception of atherosclerosis. The biomechanical examination and experimental transluminal angioplasty of the segments were carried out with special equipment developed for this purpose. The data were obtained using a TV camera assisted measurement and morphometric and histological methods. The examination of the biomechanical properties repeated after the experimental transluminal angioplasty shows the additional relative strain of the external diameter of vessel and the decrease of the arterial wall tangential elastic modulus in the circumferential direction. This suggests that if transluminal angioplasty results in sufficient structural damage of the arterial wall than there will be an improvement in the ability of the vessel diameter to increase under normal blood pressure conditions.
Assuntos
Angioplastia com Balão , Adulto , Idoso , Angioplastia com Balão/instrumentação , Angioplastia com Balão/métodos , Angioplastia com Balão/estatística & dados numéricos , Artéria Basilar/fisiologia , Fenômenos Biomecânicos , Pressão Sanguínea , Artéria Carótida Interna/fisiologia , Artérias Cerebrais/fisiologia , Humanos , Técnicas In Vitro , Pessoa de Meia-IdadeRESUMO
Surgical treatment of vertebrobasilar circulation disorders includes percutaneous transluminal angioplasty more often recently. However, the biomechanical aspects of transluminal angioplasty have not been studied sufficiently so far. 148 left and right vertebral artery segments were taken from 24 autopsy subjects (14 male and 10 female) aged from 20 to 75, who had neither systemic nor cerebrovascular lesions. Biomechanical examination and experimental transluminal angioplasty (ETA) of the tubular segments of vertebral artery (VA) were carried out by the special equipment developed for this purpose. The data were obtained using telemetrical, morphometrical and hystological methods. The biomechanical properties taken in the conditioned physiological rate are different for each segment of the VA. The stiffness of VA wall increases with age (mainly after 40 years), particularly in segments V1 and V3. Nevertheless, after high intravascular pressure application the diameter response of VA to intravascular fluid pressure increases if sufficient structural damage of the arterial wall was made.
Assuntos
Angioplastia com Balão , Insuficiência Vertebrobasilar/fisiopatologia , Adulto , Idoso , Artéria Basilar/patologia , Artéria Basilar/fisiopatologia , Fenômenos Biomecânicos , Técnicas de Cultura , Tecido Elástico/patologia , Tecido Elástico/fisiopatologia , Feminino , Humanos , Masculino , Microscopia Eletrônica , Pessoa de Meia-Idade , Túnica Íntima/patologia , Túnica Íntima/fisiopatologia , Túnica Média/patologia , Túnica Média/fisiopatologia , Resistência Vascular/fisiologia , Artéria Vertebral/patologia , Artéria Vertebral/fisiopatologia , Insuficiência Vertebrobasilar/patologiaRESUMO
Better knowledge of clinical epidemiology and course of aneurysmal subarachnoid hemorrhage (ASAH) is essential for dedicated planning of the need for services. The aim of the study was to obtain a picture of epidemiology and clinical course of ASAH in Riga City (the capital of Latvia). A retrospective population-based study included residents of Riga City who suffered their first ASAH during a 5-year period from the beginning of 1996 till the end of 2000. The total number of ASAH events in the population during the study period was 292, of which 56 (19%) were fatal before reaching the hospital. There was no significant difference between age-specific incidence rates in men and women. The mean ASAH rates per 100 000 per year were 10.3 for age-adjusted incidence (in the population aged 20-79 years) and 7.2 for crude incidence. The mean age-adjusted case fatality rates were 57% for all ASAH events and 45% for those who survived admission. Our data suggest that incidence of ASAH in Baltic population can be recognized as average compared with other European regions. However, the case fatality rate of ASAH in the study population was higher than those of SAH reported from MONICA Collaborating Centers.