Curative effect of minimally invasive puncture and drainage assisted with alteplase on treatment of acute intracerebral hemorrhage

Objective: To investigate the different effects on evacuation of hematoma, the severity of nerve injury, inflammatory reaction and oxidative stress response in the treatment of acute intracerebral hemorrhage by using minimally invasive puncture and drainage assisted with alteplase or urokinase. <br> Methods:A total of 114 patients with acute intracerebral hemorrhage treated with minimally invasive puncture and drainage in our hospital from May 2012 to October 2015 were retrospectively analyzed and divided into alteplase group and urokinase group, which received adjuvant therapy with alteplase and urokinase, respectively. Before and after treatment, CT was used for scanning, and the volume of hematoma and edema and the distance of midline shift were examined. After treatment, serum was collected for detecting the contents of molecular markers of nerve injury, inflammatory reaction and oxidative stress response. <br> Results:On the 3rd day after treatment, the volume of hematoma and edema and the distance of midline shift in minimally invasive group were significantly lower than those of craniotomy group, and incidence of intracranial infection was lower than that of craniotomy group. There was no significant difference of rebleeding incidence compared to craniotomy group. The serum contents of osteopontin, S100β, glial fibrillary acidic protein, neuron-specific enolase, myelin basic protein, neuropeptide Y, ischemia modified albumin, tumor necrosis factor alpha, interleukin-1β, interleukin-6, interleukin-8, soluble intercellular adhesion molecule-1, high-mobility group protein 1, malonaldehyde, advanced oxidation protein products and 8-hydroxy-2'-deoxyguanosine urine of patients from alteplase group were significantly lower than those of urokinase group. The content of total antioxidant capacity was obviously higher than that of urokinase group. <br> Conclusions: As for the effect on evacuation of hematoma and also the ameliorative effect on nerve injury, inflammatory reaction and oxidative stress response in treatment of acute intracerebral hemorrhage, minimally invasive puncture and drainage assisted with alteplase was superior to adjuvant therapy with urokinase.

Lingual angioedema after alteplase treatment in a patient with acute ischemic stroke

BACKGROUND: In recent years, thrombolytic therapy has become the main treatment of ischemic stroke. But the increasing use of alteplase in ischemic stroke has made some complications more evident. Angioedema is a rare but potentially life-threatening complication of alteplase treatment. Only a few studies have examined the incidence of angioedema after treatment with alteplase for stroke.METHODS: A 75-year-old man complaining of right hemiparesis was admitted to our emergency department. He was diagnosed as having acute ischemic stroke, and alteplase infusion was given two hours after the onset of stroke symptoms. Immediately after the completion of infusion he was noted to have a large swollen tongue.RESULTS: His neurological symptoms resolved gradually within 4 hours, whereas his upper extremity strength improved to 4/5 and lower extremity 5/5. Lingual edema resolved within 16 hours without any complication. He died from presumed nosocomial infection 5 days later.CONCLUSIONS: Lingual angioedema may appear as a possible complication in patients who were treated with alteplase. The management of these patients should be very careful.

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.

Differences in the effect of intravenous alteplase thrombolysis and non-thrombolytic therapy on the neurological function in patients with acute cerebral infarction

Objective:To study the differences in the effect of intravenous alteplase thrombolysis and non-thrombolytic therapy on the neurological function in patients with acute cerebral infarction as well as the specific molecular mechanism.Methods:Patients with acute cerebral infarction who were treated in our hospital between April 2013 and May 2016 were selected and randomly divided into two groups, thrombolysis group received intravenous alteplase thrombolysis and non-thrombolysis group received conventional treatment. After treatment, transcranial color Doppler ultrasound was used to assess intracranial blood flow, and serum was collected to detect blood coagulation function indexes, nerve injury indexes and inflammatory stress response indexes.Results:1 week and 2 weeks after treatment, middle cerebral artery Vs, Vd and Vm levels of thrombolysis group were significantly higher than those of non-thrombolysis group;2 weeks after treatment, serum FVIII, VWF, S100β, NSE, GFAP, MBP, UCH-L1, TNF-α, IL-1β, MDA, AOPP and 8-OHdG content of thrombolysis group were significantly lower than those of control group while PT, TT and APTT were significantly higher than those of control group.Conclusion: Intravenous alteplase thrombolysis can improve cerebral blood perfusion and alleviate nerve injury in patients with acute cerebral infarction, and inhibiting blood coagulation process as well as oxidizing and inflammatory reaction is the molecular mechanism for alteplase to achieve therapeutic action.

Efficacy and safety of single-bolus tenecteplase compared with front-loaded alteplase in Chinese patients with acute myocardial infarction

Following ST-segment elevation myocardial infarction(STEMI), early and complete epicardial reperfusion is associated with improved survival.……

Effect of alteplase thrombolysis sequenced by low molecular heparin calcium antithrombosis on the neurological function and serum cytokines in patients with cerebral infarction

Objective:To study the effect of alteplase thrombolysis sequenced by low molecular heparin calcium antithrombosis on the neurological function and serum cytokines in patients with cerebral infarction.Methods:Patients with acute cerebral infarction who received alteplase thrombolysis in Zigong Fourth People's Hospital between June 2014 and October 2016 were retrospectively analyzed and divided into the intervention group who received low molecular heparin calcium treatment and the control group who did not receive low molecular heparin calcium treatment. The serum was collected before and after treatment to determine the contents of platelet activation factors, nerve injury molecules, soluble apoptotic molecules and growth factors.Results: Serum CD62p, CD63, PAF, GMP-140, NSE, S100B, GFAP, sFas, sFasL, sTRAIL, IGF-1, VEGF, BDNF and bFGF levels of both groups of patients after treatment were lower than those before treatment, serum CD62p, CD63, PAF, GMP-140, NSE, S100B, GFAP, sFas, sFasL and sTRAIL levels of intervention group after treatment were lower than those of control group while IGF-1, VEGF, BDNF and bFGF levels were higher than those of control group.Conclusion: Alteplase thrombolysis sequenced by low molecular heparin calcium antithrombosis for acute cerebral infarction can inhibit platelet activation and cell apoptosis, alleviate nerve injury and improve neurotrophy status.

Effect of alteplase thrombolysis on nerve injury and serum cytokines in patients with cerebral infarction

Objective:To study the effect of alteplase thrombolysis on nerve injury and serum cytokines in patients with cerebral infarction.Methods: Patients with acute cerebral infarction who received thrombolytic therapy in Dongfang Hospital between May 2014 and October 2016 were retrospectively analyzed, and according to the different ways of thrombolysis, they were divided into rt-Pa group and UK group who accepted alteplase and urokinase thrombolysis respectively. Serum levels of nerve injury markers, nerve cytokines and inflammatory cytokines were detected before as well as 1 d and 7 d after thrombolytic therapy.Results:1 d and 7 d after thrombolysis, serum nerve injury markers NSE, S100B, MDA and 8-OHdG as well as inflammatory cytokines IL-1β, IL-18, TNF-α and sVCAM-1 levels of both groups of patients were significantly lower than those before treatment while nerve cytokines BDNF, NGF and VEGF levels were significantly higher than those before treatment, and serum nerve injury markers NSE, S100B, MDA and 8-OHdG as well as inflammatory cytokines IL-1β, IL-18, TNF-α and sVCAM-1 levels of rt-Pa group were significantly lower than those of UK group while nerve cytokines BDNF, NGF and VEGF levels were significantly higher than those of UK group. Conclusion: Alteplase thrombolysis for acute cerebral infarction can reduce nerve injury, improve neurotrophic state, and inhibit inflammatory response.

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.

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-

Effect of Guhong injection combined with atyplase on vascular endothelial function and fibrinolytic system and related factors in patients with acute cerebral infarction

Objective:To explore the effect of Guhong Injection combined with atyplase on vascular endothelial function and fibrinolytic system and related factors in patients with acute cerebral infarction.Methods:To select 90 patients with acute cerebral infarction in our hospital,divided into control group(48 cases)and observation group(48 cases)randomly.Patients in the control group were treated with alteplase on the basis of routine symptomatic treatment,and the observation group was treated with Guhong injection on the basis of the control group.Before and after treatment,the serum levels of related factors were detected and compared between the two groups.Results:Before treatment,there were no significant differences in serum related factors(ET-1,PAO,H-FABP,VEGF,S100β,BDNF,CEC,Fibulin-5,vWF,P-selectin,t-PA,PAI-1)between the two groups;After treatment,the serum levels of ET-1,PAO,H-FABP,S100β,CEC,Fibulin-5,vWF,P-selectin,PAI-1 in the observation group were significantly lower than those in the control group,and the serum levels of VEGF,BDNF and t-PA were higher than those in the control group,there were significant differences between the two groups.Conclusion:Guhong injection was added to patients with acute cerebral infarction on the basis of routine symptomatic treatment and ateplase,could significantly improve the level of serum related factors,it was more conducive to the control of symptoms and rehabilitation of patients,the effect was definite,it was worth further study and application in clinic.

缺血性中风：Alteplas在中风后六小时使用还有效吗？

如果在缺血性中风发作后３ｈ内用Ａｌｔｅｐｌａｓ溶栓，可以明显促进神经系统恢复正常。在ＥＣＡＳＳⅡ研究中，人们试验在中风后６ｈ内才开始用Ａｌｔｅｐｌａｓ，情况是否相同。

Thrombolysis lead to better long-term outcome in Chinese stroke patients

Aim:The rate of thrombolysis in Chinese acute ischemic stroke(AIS)was low and little was known about the long-term outcome.We aimed to compare the prognosis between thrombolysis and ordinary anti-platelet strategies in AIS.Methods:Patients,who were consecutively registered in our hospital from January 2005 to June 2012,were retrospectively studied.Inclusion criteria:(1)primary diagnoses of cerebral infarction coded with implantable cardioverter defibrillator-10 I63 to I69;(2)symptoms onset to treatment time(OTT)within 6 h;(3)thrombolysis with alteplase(TROM)or ordinary anti-platelet therapy(ANTP).Exclusion criteria:(1)symptoms and signs diminished rapidly without apparent neurological deficits;(2)no visible lesions on diffusion weighted image in magnetic resonance imaging;(3)cerebral infarction caused by serious metabolic in-balance or infections.The endpoints were defined as favorable(modified Rankin Scale 0-2)or being survival.Proportions of favorable outcome or survival were estimated by Kaplan-Meier curve and Cox regression.Results:One hundred and sixty eight cases were analyzed.Ninety one were in TROM and 77 in ANTP.Male accounted for 82(48.8%)and female 86(51.2%).The median of age was 74[interquartile range(IQR)67-79],national institute of health stroke scale(NIHSS 9)(IQR 5-17)and OTT 3.9 h(IQR 3.0-4.8)respectively.The median length of follow-up was 112(IQR 63.4-163.8)weeks.By the end of December 31,2012,87 patients(51.8%)reached favorable outcome while 81(48.2%)unfavorable.Forty five(26.8%)cases deceased.Kaplan-Meier curve estimation showed a longer favorable period of time in TROM than those in ANTP(212 weeks 95%confidence interval(CI)169.5-254.5 vs.126.9 weeks 95%CI 105.2-148.6;Log-Rank test x^(2)=19.632,P=0.000),while no significance was seen in survival time(258.0 weeks 95%CI 231.5-284.5 vs.160.8 weeks 95%CI 153.0-168.5;Log-Rank test x^(2)=2.427,P=0.119).In Cox regression,thrombolysis showed an independent protective effect for longer period of favorable outcome[202 vs.151 weeks,P=0.026,heart rate(HR)1.96,95%CI 1.958-3.540]and longer survival time instead(333 vs.170 weeks,P=0.000,HR 4.322,95%CI 1.942-9.618).The estimated proportion of favorable outcome in Chinese urban AIS was about 91%for 1 year and 50%for about 3.4 years,while the estimated proportion of survival was about 98.5%for 1 year and 50%for about 5.3 years,respectively.Conclusion:Chinese urban AIS patients who underwent thrombolysis with alteplase might have a better long-term outcome than those receiving ordinary anti-platelet therapy.

静脉注射0．6mg／kg阿替普酶对大脑中动脉闭塞患者血管和临床转归的影响

日本东北大学医学研究生院Moil等进行了一项前瞻性队列研究——日本阿替普酶临床试验Ⅱ（Japan Alteplase Clinical TrialⅡ，J-ACTⅡ），旨在进一步评价静脉注射0．6mg／kg阿替普酶对大脑中动脉闭塞患者血管和临床转归的影响。

Acute Cerebral Infarction:A Case Report

This case report describes the presentation,diagnosis,and management of a 48-year-old man with acute cerebral infarction of the left fronto-parietal-superior temporal lobe.The patient presented to the local hospital with sudden onset of right limb weakness associated with right-sided deviation of the mouth and tongue,and slurred speech.The diagnosis of middle cerebral artery occlusion was made according to clinical symptoms and signs and some diagnostic tests including non-contrast computed tomography.Thrombolytic therapy with alteplase was given at the local hospital.The patient presented to the emergency department in the First Affiliated Hospital,Zhejiang University School of Medicine 8 hours after symptom onset for cerebrovascular stenting as recommended by the local hospital.The magnetic resonance angiography was performed and the M1 segment of middle cerebral artery stenosis was made as diagnosis.After acute management the patient was transferred to the neurology department for further management.This case highlights the critical importance of timely diagnosis,severity assessment,thrombolytic therapy,and intervention in ischemic stroke.Insights gained from this case contribute to the evolving understanding of cerebrovascular events.