先前腹主动脉瘤修复的急性缺血性脑卒中患者溶栓的安全性

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-08-15 DOI:10.1016/j.jstrokecerebrovasdis.2025.108421

Walter Duarte-Celada MD , Katherine Rivas MD , Pichatorn Suppakitjanusant MD , Pamela Davila-Siliezar MD , Myriam Vijil MD , Ximena Gamboa MD , Chanaka N. Kahathuduwa MD, PhD , Riichi Ota MD , Ross Raedeke , Darko Quispe-Orozco MD

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引用次数: 0

摘要

目的静脉溶栓是急性缺血性卒中（AIS）的标准治疗方法，但其在有腹主动脉瘤（AAA）修复史患者中的安全性尚不清楚。许多溶栓的禁忌症来自关键临床试验中排除的人群，留下了AAA修复破裂风险的不确定性。本研究旨在评估有AAA修复史的AIS患者静脉溶栓的安全性。方法回顾性研究2013年至2023年间接受静脉溶栓治疗AIS的AAA修复史患者。收集的数据包括人口统计学和临床特征、动脉瘤修复的细节、腹部计算机断层血管造影（CTA）和患者结果。结果16例接受静脉溶栓治疗的有AAA修复史的患者。中位年龄86.5岁（IQR 80.8 ~ 89.8）。大多数患者（92.3%）接受了血管内修复，从AAA修复到溶栓的中位时间为10年（IQR 4.4-14.8）。没有患者在溶栓前接受腹部CTA；2例患者溶栓后CTA均显示有内漏，其中1例导致动脉瘤破裂。只有1例（6%）患者在溶栓后发生AAA破裂。3个月时的中位mRS为3 （IQR 1.8-4）。结论术前有血栓修复的患者溶栓后AAA破裂发生率较低。需要更大规模的研究来确定快速腹部CTA是否可以识别高危特征并预防危及生命的并发症。

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Safety of thrombolysis in acute ischemic stroke patients with previous aortic abdominal aneurysm repair

Objective

Intravenous thrombolysis is the standard treatment for acute ischemic stroke (AIS), but its safety in patients with a history of abdominal aortic aneurysm (AAA) repair remains unclear. Many contraindications for thrombolysis stem from populations excluded in pivotal clinical trials, leaving uncertainty about the risk of AAA repair rupture. This study aims to assess the safety of intravenous thrombolysis in AIS patients with prior AAA repair.

Methods

This is a retrospective study of patients with a prior history of AAA repair who received intravenous thrombolysis for AIS between 2013 and 2023. Data collected included demographic and clinical characteristics, details of aneurysm repair, abdominal computed tomography angiography (CTA), and patient outcomes.

Results

Sixteen patients with a history of AAA repair who received intravenous thrombolysis for AIS were included. The median age was 86.5 years (IQR 80.8–89.8). Most patients (92.3 %) had undergone endovascular repair, with a median time of 10 years (IQR 4.4–14.8) between AAA repair and thrombolysis. No patients underwent abdominal CTA prior to thrombolysis; two patients had post-thrombolysis CTA, both revealing endoleaks, one of which led to aneurysm rupture. Only one patient (6 %) experienced AAA rupture post-thrombolysis. The median mRS was 3 (IQR 1.8–4) at three months.

Conclusions

The incidence of AAA rupture after thrombolytic therapy in patients with prior repair was low. Larger studies are needed to determine whether rapid abdominal CTA could identify high-risk features and prevent life-threatening complications.

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.