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논문 기본 정보

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학술저널
저자정보
Michael G Brandel (Department of Neurosurgery University of California San Diego La Jolla CA USA) Yasmeen Elsawaf (Department of Neurosurgery University of Californ) Robert C. Rennert (Department of Neurosurgery University of California San Diego La Jolla CA USA) Jeffrey A. Steinberg (Department of Neurosurgery University of California San Diego La Jolla CA USA) David R. Santiago-Dieppa (Department of Neurosurgery University of California San Diego La Jolla CA USA) Arvin R. Wali (Department of Neurosurgery University of California San Diego La Jolla CA USA) Scott E. Olson (Department of Neurosurgery University of California San Diego La Jolla CA USA) J. Scott Pannell (Department of Neurosurgery University of California San Diego La Jolla CA USA) Alexander A. Khalessi (Neurological Surgery UCSD Department of Neurological Surgery 9300 Campus Point Drive La Jolla C)
저널정보
대한뇌혈관외과학회 Journal of Cerebrovascular and Endovascular Neurosurgery Journal of Cerebrovascular and Endovascular Neurosurgery Vol.22 No.1
발행연도
2020.1
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1 - 7 (7page)

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Objective: Although stroke guidelines recommend antiplatelets be started 24 hours after tissue plasminogen activator (tPA), select mechanical thrombectomy (MT) patients with luminal irregularities or underlying intracranial atherosclerotic disease may benefit from earlier antiplatelet administration. Methods: We explore the safety of early (< 24 hours) post-tPA antiplatelet use by retrospectively reviewing patients who underwent MT and stent placement for acute ischemic stroke from June 2015 to April 2018 at our institution. Results: Six patients met inclusion criteria. Median presenting and pre-operative National Institutes of Health Stroke Scale scores were 14 (Interquartile Range [IQR] 5.5-17.3) and 16 (IQR 13.7-18.7), respectively. Five patients received standard intravenous (IV) tPA and one patient received intra-arterial tPA. Median time from symptom onset to IV tPA was 120 min (IQR 78-204 min). Median time between tPA and antiplatelet administration was 4.9 hours (IQR 3.0-6.7 hours). Clots were successfully removed from the internal carotid artery (ICA) or middle cerebral artery (MCA) in 5 patients, the anterior cerebral artery (ACA) in one patient, and the vertebrobasilar junction in one patient. All patients underwent MT before stenting and achieved thrombolysis in cerebral infarction 2B recanalization. Stents were placed in the ICA (n=4), common carotid artery (n=1), and basilar artery (n=1). The median time from stroke onset to endovascular access was 185 min (IQR 136-417 min). No patients experienced symptomatic post-procedure intracranial hemorrhage (ICH). Median modified Rankin Scale score on discharge was 3.5. Conclusions: Antiplatelets within 24 hours of tPA did not result in symptomatic ICH in this series. The safety and efficacy of early antiplatelet administration after tPA in select patients following mechanical thrombectomy warrants further study.
#Acute ischemic stroke #Emergent stenting #Mechanical thrombectomy #Intracranial hemorrhage #Antiplatelet

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참고문헌 (41)

참고문헌 신청
Abraham P / 2017 / Vessel wall signal enhancement on 3-T MRI in acute stroke patients after stent retriever thrombectomy / Neurosurg Focus 42(4):E20 google schola Bang OY / 2019 / Endovascular therapy for acute ischemic stroke of intracranial atherosclerotic origin-neuroimaging perspectives / Front Neurol 10:269 google schola Behme D / 2017 / Emergent carotid stenting after thrombectomy in patients with tandem lesions / Stroke 48(4):1126~1128 google schola Behme D / 2015 / Emergency stenting of the extracranial internal carotid artery in combination with anterior circulation thrombectomy in acute ischemic stroke : a retrospective multicenter study / AJNR Am J Neuroradiol 36(12):2340~2345 google schola Berkhemer OA / 2015 / A randomized trial of intraarterial treatment for acute ischemic stroke / N Engl J Med 372(1):11~20 google schola

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