The Effect of the Early Application of Tirofiban on Acute Ischemic Stroke (AIS) after Intravenous Thrombolysis with Urokinase

Objective:Discussion and analysis of the effect of the early application of Tirofiban on acute ischemic stroke(AIS)after intravenous thrombolysis with urokinase.Method:The subjects of this study are 40 patients with AIS admitted at the Yibin Fourth People’s Hospital,of which were computer-randomized into a control group(20 cases,with regular urokinase intravenous thrombolysis therapy)and a research group(20 cases,combined with early Tirofiban treatment)from January 2018 to December 2022.The intervention outcomes between these two groups were compared and analyzed.Result:The blood platelet-related parameters before treatment had no statistical difference between the two groups(P>0.05),but the research group was higher than that of the control group after treatment(P<0.05).The Barthel index before treatment in both groups had no statistical difference(P>0.05),but the research group was higher than that of the control group after treatment(P<0.05).Conclusion:Early Tirofiban treatment for patients with AIS after intravenous thrombolysis with urokinase could effectively regulate the blood platelet-related parameters,hence improving treatment benefits and living capacity for patients,with definite clinical benefits.

Effects of butyphthalide + rt-PA intravenous thrombolysis on the DWI characteristics, coagulation function and neurological function in patients with acute cerebral infarction

Objective: To investigate the effects of butyphthalide + alteplase (rt-PA) intravenous thrombolysis on the diffusion-weighted imaging (DWI) characteristics, coagulation function and neurological function in patients with acute cerebral infarction. Methods: The patients with acute cerebral infarction who were admitted to our hospital between April 2015 and October 2018 and with the onset time 4.5 hours were selected and divided into the observation group receiving butyphthalide + rt-PA intravenous thrombolysis and the control group receiving rt-PA intravenous thrombolysis by random number table. The differences in DWI parameter apparent diffusion coefficient (ADC), coagulation function indexes and neurological function indexes were compared between the two groups. Results: At 7 and 14 days after treatment, the ADC values of both groups were significantly increased, and the ADC values of the observation group were significantly higher than those of the control group;at 7 days after treatment, the prothrombin time (PT) and activated partial thromboplastin time (APTT) levels in both groups were significantly prolonged whereas fibrinogen (FIB), D-dimer (D-D), platelet activating factor (PAF), P-selectin, von Willebrand factor (vWF), neuron-specific enolase (NSE), S100B protein (S100B), malondialdehyde (MDA) and endothelin-1 (ET-1) contents were significantly decreased, and the APTT and PT levels in the observation group were significantly shorter than those in the control group whereas FIB, D-D, PAF, P-selectin, vWF, NSE, S100B, MDA and ET-1 contents were significantly lower than those in the control group. Conclusion: Butyphthalide + rt-PA intravenous thrombolysis can improve the DWI characteristics, coagulation function and neurological function of patients with acute cerebral infarction.

Anticoagulation effect of low-dose and low-intensity heparin applied within 24 hours after intravenous thrombolysis for acute cerebral infarction

BACKGROUND： Studies have demonstrated that immediate anticoagulation after thrombolysis can improve the prognosis of patients with acute cerebral infarction. However, the optimal timing and means of anticoagulation therapy remain unclear. OBJECTIVE： To observe the effects and safety of heparin treatment within 24 hours after intravenous thrombolysis for acute cerebral infarction. DESIGN： Observation experiment. SETTING： Department of Neurology, the 306 Hospital of Chinese PLA. PARTICIPANTS： Fifteen acute cerebral infarction patients complicated by moderate and severe neurologic function deficits within 6 hours after attack admitted to Department of Neurology, the 306 Hospital of Chinese PLA between January 2005 and December 2006 were recruited in this study. The involved patients, 11 male and 4 female, were aged 46- 79 years. They all met the diagnosis criteria for various cerebrovascular diseases formulated by the 4th National Conference for Cerebrovascular Disease （1995） and confirmed as cerebral infarction by skull CT or MRI imageology. Informed consents were obtained from the patients or their relatives. METHODS： On admission, patients received thrombolysis with urokinase. Immediately after thrombolysis, skull CT was rechecked. Intracranial hemorrhage signs were not found by skull CT. Hemorrhage was also not found in skin, mucous membrane and internal organs. Six hours later, low-dose low-intensity heparin 4 - 8 IU/kg per hour was intravenously administrated for anticoagulation for 7 - 10 days successively. MAIN OUTCOME MEASURES： Neurologic function was evaluated before, immediately 6 hours and 14 days after thrombolysis by scoring standard of clinical neurologic function deficit degree for stroke patients （1995）. Activities of daily living of patients with stroke were evaluated 90 days after thrombolysis by modified Rankin Scale. RESULTS： Fifteen involved patients participated in the final analysis. ① Comparison of clinical neurologic function deficit degree of patients at different time： Neurologic function deficit score at the end of thrombolysis was significantly lower than that before thrombolysis （t =3.45, P 〈 0.01）. Neurologic function deficit score 6 hours after thrombolysis was higher than that at the end of thrombolysis, and neurologic deficits were increased, but no significant difference was found （P 〉 0.05）. Neurologic function deficit score 14 days after thrombolysis was significantly lower than that before thrombolysis （t =4.769, P 〈 0.01）. ②Therapeutic effect and modified Rankin scale results： 14 days after thrombolysis, 4 patients were basically cured, 7 significantly improved, 2 improved and 2 worsened. The total improvement rate of neurologic function deficit was 86.7%. Ninety days after thrombolysis, according to modified Rankin Scale, score was 0 to 2 in 12 patients （80%）, 3 to 4 in 2 patients （13.3%） and 6 in 1 patient （6.7%）. Complications of intracranial hemorrhage were not found in patients within 14 days after thrombolysis. CONCLUSION： Low-dose and low-intensity heparin applied within 24 hours after intravenous thrombolysis has good safety and efficacy in the treatment of acute cerebral infarction.

Intravenous thrombolysis for acute ischemic stroke with extended time window

Background:Intravenous thrombolysis(IVT)is an effective way for treating acute ischemic stroke(AIS).However,its effects have not been established among AIS patients with unclear stroke symptoms or with stroke onset for>4.5 h.Methods:We searched PubMed,Embase,Web of Science,Cochrane Central Register of Controlled Trials and Google Scholar databases for randomized controlled trials that compared IVT(IVT group)and placebo or usual care(control group[CG])in AIS patients with disease onset for>4.5 h.The outcomes of interest included the favorable functional outcome(defined as modified Rankin Scale[mRS]scores 0–1)at 90 days,the functional independence(defined as mRS scores 0–2)at 90 days,proportion of patients with symptomatic intracerebral hemorrhage(sICH)and death at 90 days.We assessed the risk of bias using the Cochrane tool.Pre-specified subgroup analyses were performed by age(70 years or>70 years),National Institute of Health Stroke Scale(NIHSS,10 or>10)and time window(4.5–9.0 h or>9.0 h).Results:Four trials involving 848 patients were eligible.The risk of bias of included trials was low.Patients in the IVT group were more likely to achieve favorable functional outcomes(45.8%vs.36.7%;OR 1.48,95%CI 1.12–1.96)and functional independence(63.8%vs.55.7%;OR 1.43,95%CI 1.08–1.90)at 90 days,but had higher risk of sICH(3.0%vs.0.5%;OR 5.28,95%CI 1.35–20.68)at 90 days than those in the CG.No significant difference in death at 90 days was found between the two groups(7.0%vs.4.1%;OR 1.80;95%CI 0.97–3.34).Conclusions:Use of IVT in patients with extended time window may improve their functional outcomes at 90 days,although IVT may induce increased risk of sICH.Care of these patients should well balance the potential benefits and harms of IVT.

Factors associated with early neurological deterioration after intravenous thrombolysis with alteplase in patients with acute ischemic stroke

Objective To investigate the risk factors of early neurological deterioration(END)after intravenous thrombolysis(IVT)in patients with acute ischemic stroke(AIS).Methods We screened consecutive AIS patients from January 2006 to May 2015 in Tangshan Gongren Hospital.In this study,all patients were treated with in-

Early intravenous administration of tirofiban is recommended in patients with acute ischemic stroke treated with alteplase:a meta-analysis

Background:The occurrence of early neurological deterioration following intravenous thrombolysis(IVT)is considered a particularly ominous clinical event and is strongly correlated with poor outcomes.Initiating tirofiban within 24 h after IVT has been suggested as a better treatment option to achieve long-term functional outcomes.However,the rationality of this remedy is a controversial.The purpose of the study was to evaluate the safety and efficacy of early intravenous tirofiban administration after IVT in patients with acute ischemic stroke(AIS).Methods:Databases including PubMed,EMBASE,Cochrane Library,and Web of Science were searched for clinical trials on early tirofiban implementation after IVT in patients with AIS from inception to September 2022.Odds ratios(ORs)were generated for dichotomous variants via meta-analysis using STATA 17.0 MP.Results:Five clinical trials with 725 patients were eligible.The study outcomes demonstrated that early tirofiban administration after IVT was not associated with symptomatic intracranial hemorrhage(OR,0.78;95%confidence interval(CI),0.22–2.74;P=0.70),asymptomatic intracranial hemorrhage(OR,1.11;95%CI,0.52–2.37;P=0.80),systemic bleeding(OR,0.97;95%CI,0.42–2.23;P=0.94),and death(OR,1.05;95%CI,0.47–2.31;P=0.91),but may reduce the incidence of early neurological deterioration(OR,0.09;95%CI,0.02–0.50;P=0.01),and was significantly associated with 90-day excellent(modified Rankin scale score 0–1)(OR,2.01;95%CI,1.35–3.02;P=0.00)and favorable(modified Rankin scale score 0–2)(OR,2.30;95%CI,1.63–3.23;P=0.00)functional outcomes.Conclusion:The early intravenous administration of tirofiban after IVT in patients with AIS may be a safe and effective treatment strategy that improves long-term neurological functional outcomes without increasing the risk of adverse events.

Effects of Intravenous Thrombolytic Therapy with Alteplase on Neurological Function,Coagulation Function and Serum Inflammatory Factors in Patients with Acute Cerebral Infarction

Objective:To investigate the effects of intravenous thrombolysis therapy with alteplase on neurological function,coagulation function and serum inflammatory factors in patients with acute cerebral infarction.Methods:A total of 96 patients with acute cerebral infarction admitted to our hospital from September 2017 to October 2019 were randomly divided into two groups,with 48 patients in each group.The control group(n=48)received routine treatment,and the observation group received intravenous thrombolysis therapy with alteplase on the basis of routine treatment.The neurological deficit score,prothrombin time(PT),activated partial thromboplastin time(APTT),tumor necrosis factor-a level(TNF-α),and high-sensitivity C-reactive protein(hs-CRP)were compared between the two groups after 15 days of treatment.Results:After treatment,NIHSS scores in both groups were lower than those before treatment;PT levels were increased,while APTT,TNF-αand hs-CRP levels were all decreased in both groups,and the changes in the observation group were greater than those in the control group,with statistically significant difference(P<0.05).Conclusions:Intravenous thrombolysis therapy with alteplase can improve the neurological function,coagulation function and serum levels of inflammatory factors in patients with acute cerebral infarction,which is worthy of clinical application.

Computed tomography perfusion and computed tomography angiography for prediction of clinical outcomes in ischemic stroke patients after thrombolysis

Cerebral blood perfusion and cerebrovascular lesions are important factors that can affect the therapeutic efficacy of thrombolysis.At present,the majority of studies focus on assessing the accuracy of lesion location using imaging methods before treatment,with less attention to predictions of outcomes after thrombolysis.Thus,in the present study,we assessed the efficacy of combined computed tomography（CT） perfusion and CT angiography in predicting clinical outcomes after thrombolysis in ischemic stroke patients.The study included 52 patients who received both CT perfusion and CT angiography.Patients were grouped based on the following criteria to compare clinical outcomes：（1） thrombolytic and non-thrombolytic patients,（2） thrombolytic patients with CT angiography showing the presence or absence of a vascular stenosis,（3） thrombolytic patients with CT perfusion showing the presence or absence of hemodynamic mismatch,and（4） different CT angiography and CT perfusion results.Short-term outcome was assessed by the 24-hour National Institution of Health Stroke Scale score change.Long-term outcome was assessed by the 3-month modified Rankin Scale score.Of 52 ischemic stroke patients,29 were treated with thrombolysis and exhibited improved short-term outcomes compared with those without thrombolysis treatment（23 patients）.Patients with both vascular stenosis and blood flow mismatch（13 patients） exhibited the best short-term outcome,while there was no correlation of long-term outcome with CT angiography or CT perfusion findings.These data suggest that combined CT perfusion and CT angiography are useful for predicting short-term outcome,but not long-term outcome,after thrombolysis.

Association of apolipoprotein E gene polymorphism with the occurrence and therapeutic effect of ischemic stroke

At present,ischemic stroke seriously affects people's life and health,and its occurrence,development and therapeutic effect are affected by many factors.With the deep research on ischemic cerebral apoplexy disease,people have a deeper understanding of its virulence genes.The apolipoprotein E genotype is the research focus recently,its genetic type is not only involved in the occurrence and development of ischemic cerebral apoplexy,but also causes different therapeatic effects.In this paper,we reviewed the relationship between apolipoprotein E gene polymorphism and lipid metabolism and atherosclerosis in ischemic stroke,as well as the differences in the therapeutic effects of thrombolysis,thrombectomy and lipid-lowering among different genotypes.

Acute ischemic Stroke combined with Stanford type A aortic dissection:A case report and literature review

BACKGROUND Acute aortic dissection(AAD)is a high mortality disease that can lead to acute ischemic strokes(AIS).Some of the patients with AAD combined with AIS initially present with neurological symptoms,which can easily lead to missed or delayed AAD diagnosis.This is attributed to the lack of physician awareness or the urgency of patient thrombolysis.Intravenous administration of thrombolytic therapy(IVT)for AAD is associated with poor prognostic outcomes.We report a patient with AIS combined with AAD who developed a massive cerebral infarction after receiving IVT for a missed AAD diagnosis.CASE SUMMARY A 49-year-old man was admitted to a local hospital with an acute onset of leftsided limb weakness accompanied by slurred speech.The patient had a history of hypertension that was not regularly treated with medication.Physical examination revealed incomplete mixed aphasia and left limb hemiparesis.Cranial computed tomography(CT)scan showed bilateral basal ganglia and lateral ventricular paraventricular infarct lesions.The patient was diagnosed with AIS and was administered with IVT.After IVT,patient’s muscle strength and consciousness deteriorated.From the local hospital,he was referred to our hospital for further treatment.Emergency head and neck CT angiography(CTA)scans were performed.Results showed multiple cerebral infarctions,and aortic dissection in the ascending aorta,innominate artery,as well as in the right common carotid artery.Then,the CTA of thoracoabdominal aorta was performed,which revealed a Stanford type A aortic dissection and aortic dissection extending from the aortic root to the left external iliac artery.Laceration was located in the lesser curvature of the aortic arch.AAD complicated with AIS was considered,and the patient was immediately subjected to cardiovascular surgery for treatment.The next day,the patient underwent aortic arch and ascending aortic replacement and aortic valvuloplasty.CONCLUSION Clinical manifestations for AAD combined with AIS are diverse.Some patients may not exhibit typical chest or back pains.Therefore,patients should be carefully evaluated to exclude AAD before administering IVT in order to avoid adverse consequences.

Clinical treatment strategy of acute cerebral infarction complicated with pulmonary embolism: a case report

This article describes the clinical characteristics of a case of cerebral infarction complicated with pulmonary embolism(PE),and elaborates the therapeutic strategies of intravenous thrombolysis and anticoagulation.Treatment remedies:the medical history and examination data of a patient with aphasia and right hemiplegia were collected.After intravenous thrombolysis and pulmonary artery CTA(computed tomographic angiography),the patient was found to have low blood oxygen saturation and PE.And the patient was treated with anticoagulant therapy.Post treatment evaluating:cerebral hemorrhage was excluded by craniocerebral CT(computed tomographic),and left basal ganglia infarction was diagnosed.After thrombolysis,the symptoms of aphasia and hemiplegia were significantly improved.For PE,after anticoagulant therapy,the patient’s breathing was stable and blood oxygen saturation was normal.For deep venous thrombosis of both lower extremities,anticoagulant therapy was continued.Conclusion:patients with thrombophilia are prone to cerebral embolism,PE and deep venous thrombosis of lower limbs.Intravenous thrombolytic therapy in acute phase and heparin anticoagulant therapy in recovery period can effectively control the disease.

Factors Associated with Thrombolysis Outcome in Ischemic Stroke Patients with Atrial Fibrillation

The outcome of early intravenous thrombolysis for ischemic stroke in patients with atrial fibrillation（AF）is worse than that without thrombosis. How to increase the efficacy of intravenous thrombolysis for AF-related ischemic stroke remains largely unknown. In this study, we investigated factors that influence the effect of intravenous thrombolysis in these patients. Our results showed that thrombolysis was independently associated with a favorable outcome（P ／ 0.001） and did not influence the mortality of AF-related ischemic stroke, although it increased the risk of hemorrhage within 24 h after treatment. Risk factors for a poor outcome at admission were：heart failure（P = 0.045）; high systolic pressure（P = 0.039）; high blood glucose（P = 0.030）; and a high National Institutes of Health Stroke Scale（NIHSS） score（P ／ 0.001）. Moreover, high systolic pressure at admission（P = 0.007）, high blood glucose（P = 0.027）, and a high NIHSS score（P ／ 0.001） were independent risk factors for mortality at 3 months. Besides thrombolysis, a high NIHSS score（P = 0.006） and warfarin taken within 48 h before stroke onset（P = 0.032） were also independent risk factors for symptomatic hemorrhage within 24 h after treatment. Ischemic stroke patients with AF benefited from intravenous thrombolysis with recombinant tissue plasminogen activator within 4.5 h after stroke.

Early Neurological Deterioration after Recanalization Treatment in Patients with Acute Ischemic Stroke： A Retrospective Study

Background： Early neurological deterioration （END） is a prominent issue after recanalization treatment. However. few studies have reported the characteristics of END after endovascular treatment （EVT） as so far. This study investigated the incidence, composition, and outcomes of END after intravenous recombinant tissue plasminogen activator （IV rt-PA） and EVT of acute ischemic stroke, and identified risk factors for END. Methods： Medical records of patients who received recanalization treatment between January l, 2014, and December 31, 2015 were reviewed. Patients were classified into IV rt-PA or EVT group according to the methods ofrecanalization treatment. The END was defined as an increase in the National Institutes of Health Stroke Scale （N1HSS） ≥4 or an increase in la of NIHSS ≥I within 72 h after recanalization treatment. Clinical data were compared between the END and non-END subgroups within each recanalization group. Results： Of the 278 patients included in the study, the incidence of END was 34.2%. The incidence rates of END were 29.8% in the IV rt-PA group and 40.2% in the EVT group, lschemia progression （68.4%） was the main contributor to END followed by vasogenic cerebral edema （21. 1%） and symptomatic intracranial hemorrhage （10.5%）. Multivariate logistic regression showed that admission systolic blood pressure （SBP） ≥160 mmHg （odds ratio [OR]： 2.312, 95% confidence interval [CI]： 1.105-4.837） and large artery occlusion after IV rt-PA （OR： 3.628.95% （7： 1.482-8.881 ） independently predicted END after IV rt-PA; and admission SBP 〉 140 mmHg （OR： 5.183, 95% CI：1.967 13.661 ）, partial recanalization （OR： 4.791,95% CI： 1.749-13.121 ）, and nonrecanalization （OR： 5.952, 95% CI： 1.841-19.243） independently predicted END alter EVT. The mortality rate and grave outcome rate at discharge of all the END patients （26.3% and 55.8%） were higher than those of all the non-END patients （1.1% and 18.6%： P 〈 0.01）. Conclusions： END was not an uncommon event and associated with death and grave outcome at discharge. High admission SBP and unsatisfactory recanalization of occluded arteries might predict END.