Unilateral orolingual angioedema in a patient with sarcoidosis after intravenous thrombolysis due to acute stroke without improvement after treatment with icatibant

2020 ◽  
Vol 13 (12) ◽  
pp. e236643
Author(s):  
Anna Daniela Wollmach ◽  
Daniel Zehnder ◽  
Markus Schwendinger ◽  
Alexander Andrea Tarnutzer
Keyword(s):  
Risk Factor ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Ace Inhibitors ◽  
Intravenous Thrombolysis ◽  
Plasminogen Activators ◽  
Potential Complication ◽  
Tissue Plasminogen ◽  
History Of ◽  
Complement Pathways

A potential complication after intravenous administration of recombinant tissue plasminogen activators (rtPAs) for thrombolysis in acute ischaemic stroke is orolingual angioedema, with an incidence of 0.4%–7.9%. In the herewith reported case, we discuss potential links between a history of sarcoidosis and the occurrence of orolingual angioedema after rtPA administration. Sarcoidosis is often accompanied by an elevated ACE level. In contrast, low ACE levels appear to play a role in the pathomechanism currently assumed to trigger angioedema, that is, the activation of the bradykinin and complement pathways. Medication with ACE inhibitors is considered a risk factor for angioedema. Based on these considerations, the patient was also treated with icatibant, a bradykinin B2-receptor antagonist, which has been found useful in recent publications on treating orolingual angioedema after intravenous lysis in ischaemic stroke.

Stroke thrombolysis in the very elderly

2010 ◽  
Vol 20 (4) ◽  
pp. 261-267
Author(s):  
Cora McGreevy ◽  
Alan Moore ◽  
Ciaran Donegan ◽  
David JP Williams
Keyword(s):  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Specific Treatment ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Evidence Base ◽  
Future Research ◽  
Very Elderly ◽  
Tissue Plasminogen ◽  
Neuroimaging Techniques

SummaryAcute ischaemic stroke is common in older people and is associated with a higher morbidity and mortality compared with younger patients. Intravenous thrombolysis with recombinant tissue plasminogen activator (r-tPA) has become the mainstay of treatment and is the only evidence-based specific treatment for acute ischaemic stroke. However, little data are available on the safety of thrombolysis in the over-80 years age group due to under-representation of this group in trials and the upper age limit for licensing of the drug. In this review, we look at the pathophysiology of stroke and recent advances in neuroimaging techniques. We also look at the evidence base for use of thrombolysis in stroke and in particular analyse the trials that include the very elderly as subjects. Finally, issues around ongoing trials and future research are discussed.

Intravenous thrombolysis in patients with acute ischaemic stroke with history of prior ischaemic stroke within 3 months

2019 ◽  
pp. jnnp-2019-320422
Author(s):  
Georgios Tsivgoulis ◽  
Aristeidis H Katsanos ◽  
Peter D Schellinger ◽  
Martin Köhrmann ◽  
Thorsten Steiner ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Intravenous Thrombolysis ◽  
History Of

scholarly journals Risk factors of haemorrhagic transformation for acute ischaemic stroke in Chinese patients receiving intravenous recombinant tissue plasminogen activator: a systematic review and meta-analysis

2018 ◽  
Vol 3 (4) ◽  
pp. 203-208 ◽  
Author(s):  
Yijia Guo ◽  
Yaqiong Yang ◽  
Muke Zhou ◽  
Li He
Keyword(s):  
Risk Factors ◽  
Ischaemic Stroke ◽  
Plasminogen Activator ◽  
Acute Ischaemic Stroke ◽  
Meta Analysis ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Chinese Patients ◽  
Haemorrhagic Transformation ◽  
Tissue Plasminogen

ObjectiveTo identify risk factors for haemorrhagic transformation in Chinese patients with acute ischaemic stroke treated with recombinant tissue plasminogen activator.MethodsWe searched electronic databases including PubMed, EMBASE, CNKI and WanFang Data for studies reporting risk factors of haemorrhagic transformation after intravenous thrombolysis. Pooled OR, weighted mean difference (WMD) and 95% CI were estimated. Meta-analysis was performed by using Stata V.14.0 software.ResultsA total of 14 studies were included. The results indicated that older age (WMD=3.46, 95% CI 2.26 to 4.66, I2=47), atrial fibrillation (OR 2.66, 95% CI 1.85 to 3.81, I2=28), previous stroke (OR 1.68, 95% CI 1.08 to 2.60, I2=14), previous antiplatelet treatment (OR 1.67, 95% CI 1.17 to 2.38, I2=0), higher National Institute of Health stroke scale scores (OR 1.10, 95% CI 1. 05 to 1.15, I2=36), systolic (WMD=4.75, 95% CI 2.50 to 7.00, I2=42) or diastolic (WMD=2.67, 95% CI 1.08 to 4.26, I2=35) pressure, and serum glucose level (WMD=1.44, 95% CI 0.62 to 2.26, I2=66) were associated with increased risk of post-thrombolysis haemorrhagic transformation.ConclusionThe current meta-analysis identified eight risk factors for post-thrombolysis haemorrhagic transformation in Chinese patients with acute ischaemic stroke. Given the risk of bias, these results should be explained with caution and do not justify withholding intravenous thrombolysis.

Carotid endarterectomy following thrombolysis for acute ischaemic stroke

VASA ◽  
2017 ◽  
Vol 46 (2) ◽  
pp. 116-120 ◽  
Author(s):  
Naz Ahmed ◽  
Damian Kelleher ◽  
Manmohan Madan ◽  
Sarita Sochart ◽  
George A. Antoniou
Keyword(s):  
Ischaemic Stroke ◽  
Carotid Endarterectomy ◽  
Acute Ischaemic Stroke ◽  
Intravenous Thrombolysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Wound Complications ◽  
Cardiac Complications ◽  
High Dependency ◽  
Low Incidence

Abstract. Background: Insufficient evidence exists to support the safety of carotid endarterectomy (CEA) following intravenous thrombolysis (IVT) for acute ischaemic stroke. Our study aimed to report a single-centre experience of patients treated over a five-year period. Patients and methods: Departmental computerised databases were interrogated to identify patients who suffered an ischaemic stroke and subsequently underwent thrombolysis followed by CEA. Mortality and stroke within 30 days of surgery were defined as the primary outcome end points. Results: Over a five-year period, 177 out of a total of 679 carotid endarterectomies (26 %) were performed in patients presenting with acute ischaemic stroke. Twenty-five patients (14 %) received IVT prior to CEA in the form of alteplase. Sixty percent of patients were male with a mean age of 68 years. Sixteen patients (64 %) underwent CEA within 14 days of IVT and the median interval between thrombolysis and CEA was 7.5 days (range, 3–50 days). One female patient died of a further intraoperative stroke within 30 days of surgery, yielding a mortality rate of 4 %. Two patients (8 %) suffered from cardiac complications postoperatively resulting in a short high dependency unit stay. Another two patients (8 %) developed local wound complications, which were managed conservatively without the need for re-operation. The median hospital length of stay was 4.5 days (range, 1–33 days). Conclusions: Our experience indicates that CEA post-thrombolysis has a low incidence of mortality. Further high quality evidence is required before CEA can be routinely recommended following IVT for acute ischaemic stroke.

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