Objective To analyze the influencing factors of hemorrhagic transformation (HT) after intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in patients with acute ischemic stroke (AIS). Methods AIS patients hospitalized in the Department of Neurology of the First Affiliated Hospital of Zhengzhou University between June 2017 and June 2020 and receiving rt-PA intravenous thrombolysis were selected. Patients were divided into two groups according to whether they had HT, HT group and non-HT group. General data such as patient’s age, sex, past history, score of National Institute of Health Stroke Scale (NIHSS) before thrombolysis, and related biochemical examination indicators were collected, to analyze the difference between the patients with HT or not, and analyze the related factors affecting the HT of AIS patients after intravenous thrombolysis. Results A total of patients 323 were included. Among them, 46 cases (14.2%) had HT, and 277 cases (85.8%) had no-HT. Except for serum free triiodothyronine (FT3), atrial fibrillation, hypertension, cerebral infarction area, NIHSS score before thrombolysis, uric acid, blood glucose before thrombolysis, white blood cell count, albumin level, alanine aminotransferase, aspartate aminotransferase / alanine aminotransferase and C-reactive protein (P<0.05), there was no significant difference in other indexes between the two groups (P>0.05). Logistic regression analysis showed that NIHSS score≥13 before thrombolysis, aspartate aminotransferase / alanine aminotransferase, blood glucose before thrombolysis≥12.74 mmol/L, low FT3 level, massive cerebral infarction, and atrial fibrillation were independent risk factors for HT after thrombolysis in AIS. Conclusions FT3 and aspartate aminotransferase / alanine aminotransferase levels may be good biomarkers for predicting HT after intravenous thrombolysis. For patients with reduced albumin and uric acid levels, supplementation of exogenous uric acid and albumin may help reduce the risk of HT after AIS thrombolysis.
ObjectivesTo systematically review the efficacy and safety of catheter-directed thrombolysis (CDT) versus anti-coagulation (AC) for deep vein thrombosis (DVT). MethodsWe searched PubMed, EMbase, The Cochrane Library, Web of Science, WanFang Data and CNKI databases to collect randomized clinical trials (RCTs) about CDT versus AC for DVT from inception to March 2018. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 5 RCTs and 989 patients were included. Meta-analysis showed that there was no significant difference between the two group in incidence of post-thrombotic syndrome (RR=0.73, 95%CI 0.49 to 1.09, P=0.13), iliofemoral venous patency rate (RR=2.57, 95%CI 0.59 to 11.24, P=0.21), bleeding (RR=2.03, 95%CI 0.50 to 8.28, P=0.32), severe bleeding (RR=1.77, 95%CI 0.91 to 3.42, P=0.09) and recurrence rate of venous thromboembolism (RR=1.00, 95%CI 0.42 to 2.36, P=0.99). However, the incidence of moderate-severe PTS decreased in CDT group was lower than that in the control group (RR=0.70, 95%CI 0.53 to 0.92, P=0.01). ConclusionsCompared with the control group, catheter-directed thrombolysis does not reduce the incidence of PTS and VTE recurrence rate, cannot improve the long-term patency of the iliofemoral vein, yet can prevent the occurrence of moderate to severe PTS. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo evaluate the safety and mid-to-long term outcomes of catheter-directed thrombolysis (CDT) in combination with percutaneous mechanical thrombectomy (PMT) followed by stent placement treatment for acute proximal deep vein thrombosis (DVT) complicated by iliac vein compression syndrome (IVCS), and to identify risk factors relevent to primary stent restenosis. MethodsA retrospective study was conducted. The patients diagnosed with acute proximal DVT and concurrent IVCS who underwent CDT in combination with PMT followed by stent placement at the First Affiliated Hospital of Chongqing Medical University from January 2018 to December 2021 were included. The demographics, clinical history, and procedural data were collected. The postoperative follow-up using color Doppler ultrasound were scheduled at 3, 6, and 12 months, and annually thereafter. The primary and secondary stent patency rates were evaluated. The univariate and multivariate Cox proportional hazards regression models were employed to assess risk factors for primary stent restenosis. ResultsA total of 188 patients who met the inclusion and exclusion criteria were enrolled, underwent CDT combined with PMT and stent implantation, and completed follow-up. During the follow-up, the restenosis occurred in 26 patients. The cumulative primary patency rates at 3, 6, 12, 24, 36, and 48 months after surgery were 100%, 98.9%, 92.5%, 88.3%, 86.7%, and 86.2%, respectively. The multivariate Cox proportional hazards regression analysis confirmed that a history of previous DVT [HR (95%CI)=4.21 (1.73, 10.28), P=0.002], implantation of two or more stents [HR (95%CI)=11.85 (1.66, 84.63), P=0.014], stent crossing the inguinal ligament [HR (95%CI)=9.92 (1.87, 52.78), P=0.007], and stent length [HR (95%CI)=0.98 (0.97, 0.99), P=0.003] were the affecting factors for primary restenosis. ConclusionsThe findings of this study suggest that CDT combined with PMT and stent implantation is a safe and effective strategy for treating acute proximal DVT complicated by IVCS. Close attention should be paid to the occurrence of restenosis in patients with two or more stents, stent crossing the inguinal ligament, and a history of previous DVT.
ObjectiveTo observe and compare the efficacy and safety of intravenous thrombolysis with alteplase or urokinase in the first-ever acute ischemic stroke patients arriving at the hospital 3.5-4.5 h after onset.MethodsClinical data of patients with acute ischemic stroke treated in Shihezi People’s Hospital between January 2019 and October 2020 were prospectively collected. The National Insititutes of Health Stroke Scale (NIHSS) score on the 7th day and the 90th day, the modified Rankin Scale (mRS) score and the Blessed Behavior Scale (BBS) score on the 90th day, and symptomatic bleeding within 36 h after thrombolysis were analyzed and compared between the patients receiving alteplase threatment (the alteplase group) and the ones receiving urokinase treatment (the urokinase group).ResultsTotally 96 patients were treated with intravenous thrombolysis. Among them, 58 patients received alteplase threatment and 38 received urokinase treatment. The difference in NIHSS, mRS, or BBS scores between the two groups before treatment was not statistically significant (P>0.05). On the 90th day after treatment, the NIHSS, mRS, and BBS scores of the alteplase group were 3.59±3.73, 2.26±1.26, and 15.33±8.28, respectively, and those of the urokinase group were 5.95±4.88, 3.00±0.87, and 20.37±11.80, respectively; the differences between the two groups were all statistically significant (P<0.05). There was no significant difference in the rate of symptomatic intracerebral hemorrhage between the two groups within 36 h after treatment (P>0.05). Multiple linear regression analyses showed that the treatment method was related to the NIHSS score on the 7th day, the NIHSS score on the 90th day, the mRS score on the 90th day, and the BBS score on the 90th day (P<0.05), the history of heart disease was related to the mRS score on the 90th day (P<0.05), and the income was related to the BBS score on the 90th day (P<0.05).ConclusionFor the hyperactue ischemic stroke, the overall effect of alteplase treatment may be better than that of urokinase treatment.
ObjectiveTo explore the effect of catheter directed thrombolysis (CDT) in treatment of acute deep venous thrombosis (ADVT) in lower extremity.
MethodsLimb circumference at 15 cm above and below the knee at affected side, as well as patency improvement score of 46 patients with ADVT in lower extremity, who received treatment in The Rocket Army General Hospital of PLA between January 2014 and October 2015, were colleted retrospectively, to analyze the effect of CDT in treatment of ADVT in lower extremity.
ResultsAll patients were placed catheter successfully, 5 patients were placed catheter by 'contralateral mountain' technique retrograde, 40 patients were placed catheter through the limb popliteal vein at affected side anterograde, guiding by ultrasound, 1 patient was placed catheter through femoral vein at affected side. All of 46 patients got successful thrombolysis, and thrombolysis time was (4.7±1.8) d (3-12 d). There were 8 patients suffered from complications in different situation, and got treatment of drug withdrawal or tube drawing all ease, no one died. Compared with before CDT treatment in same group, the limb circumference at 15 cm above (P=0.028, P=0.017, P=0.031) and below (P=0.035, P=0.038, P=0.047) the knee at affected side, and patency improvement score (P=0.023, P=0.028, P=0.031) in all patients group, 22-45 years group, and 46-74 years group were all lower after CDT treatment. The limb circumference at 15 cm above (P=0.073, P=0.387, P=0.358) and below (P=0.416, P=0.625, P=0.253) the knee at affected side after CDT treatment were not differed with corresponding indexes of healthy side in the same group of all patients group, 22-45 years group, and 46-74 years group. Ultrasound after treatment showed that, blood vessel recanalization occurred in 15 patients (32.6%), partial blood vessel recanalization occurred in 28 patients (60.9%), but thrombus of 3 patients (6.5%) didn't removed, the total effective rate was 93.5% (43/46). Forty three patients were followed up for 1-24 months, the median is 18-month. During follow-up period, skin color obviously deepened after the activity occurred in 5 patients, obvious limb acid bilges occurred in 19 patients, vein thrombosis (DVT) recurred in 9 patients of 28 patients with partial blood vessel recanalization, in addition, thrombosis syndrome (PTS) occurred in 11 patients.
ConclusionCDT is the most direct and effective way to treat ADVT.
ObjectiveTo evaluate the effect of percutaneous mechanical thrombectomy (PMT) with AngioJet mechanical thrombus aspiration system for the acute deep venous thrombosis (DVT) of lower extremities. MethodsThe clinical data of 72 patients (72 limbs) with acute DVT who underwent PMT with AngioJet system from December 2015 to June 2018 in our hospital were analyzed retrospectively. ResultsOf the 72 cases, 30 cases underwent PMT alone, while 42 cases underwent PMT combined with catheter directed thrombolysis (CDT). Thrombus clearance rate of grade Ⅲ was obtained in 49 cases (68.05%), grade Ⅱ in 20 cases (27.78%), and grade Ⅰ in 3 cases (4.17%). Thirty-five cases were found with May-Thurner syndrome, and 34 cases were treated with stenting while 1 case complicated with iliac bleeding. The rates of PTS were 1.41% (1/71), 3.57% (2/56), 4.55% (2/44), and 20.00% (3/15) at 3-month, 6-month, 1-year, and 2-year after intervention, respectively. The deep vein patency rates were 86.36% (38/44) and 80.00% (12/15) at 1-year and 2-year after intervention, respectively. The iliac stent patency rates were 100% (23/23) and 87.50% (7/8) at 1-year and 2-year after intervention, respectively. ConclusionThe effect of PMT assisted with CDT for the acute DVT of lower extremities is satisfactory, but its long-term efficacy needs to be further observed.
ObjectiveTo explore the relevance of an increase in neutrophil count and early neurological deterioration (END) after intravenous thrombolysis in patients with acute ischemic stroke.MethodsA retrospective study was conducted on the patients who received thrombolysis treatment of alteplase within 4.5 hours after onset between January 2017 and November 2018. Based on the existence of END, the patients were divided into the END group and the non-END group. Univariate and multivariate logistic regression, and receiver operating characteristic curves were used to analyze the relevances between END and the indexes such as neutrophil count, lymphocyte count, and neutrophil to lymphocyte ratio (NLR) after thrombolysis. Paired sample t test and Wilcoxon signed-rank test were used to compare the changes of neutrophil and lymphocyte before and after thrombolysis.ResultsA total of 187 patients were included, including 48 in the END group and 139 in the non-END group. Before thrombolysis, the differences of total protein (t=2.130, P=0.035) and albumin (t=2.777, P=0.007) between the two groups were statistically significant, but the differences in other clinical indexes between the two groups were not statistically significant (P>0.05). After thrombolysis, white blood cell count, neutrophil count, NLR, fibrinase degradation product, baseline and change of National Institute of Health Stroke Scale score, proportion of cardiogenic embolism, degree of responsible vascular stenosis and anterior circulation cortical infarction site were all higher in the END group than those in the non-END group (P<0.05). The total protein, albumin, lymphocyte count and prealbumin in the END group were lower than those in the non-END group (P<0.05). Neutrophil in the END group increased significantly (Z=?2.314, P=0.021) after thrombolysis. Neutrophil count [odds ratio=1.288, 95% confidence interval (1.069, 1.552)] was one of the independent influencing factors of venous thrombolysis END, and the specificity was the highest (the sensitivity was 62.5%, and the specificity was 71.9%).ConclusionsAfter thrombolysis, elevated neutrophil count has some relevance to END. Dynamic monitoring on neutrophil count after intravenous thrombolysis treatment can predict the occurrence of END.
ObjectiveTo compare vein valve function following pharmacomechanical thrombolysis (PMT) with simple catheter-directed thrombolysis (CDT) for deep vein thrombosis.MethodsWe retrospectively analyzed the clinical data of sixty patients who suffered acute lower extremity deep vein thrombsis in our hospital between October 2016 and March 2017. All patients underwent contralateral preprocedural duplex and bilateral postprocedure duplex to access patency and valve function. The patients were divided into three groups including a group A with catheter-directed thrombolysis (CDT) alone (36 patients with 20 males and 16 females at average age of 56 years), a group B with PMT alone (15 patients with 8 males and 7 females at average age of 55 years), and a group C with PMT combined CDT (9 patients with 4 males and 5 females at average age of 56 years). The valve function was compared among the Group A, Group B and Group C.ResultsThere were 40.0% (24/60) patients with bilateral femoral vein valve reflux, 40.0% (24/60) patients with unilateral femoral vein valve reflux (all in the treated limbs), 20% (12/60) patients had no reflux in both limbs. Of the limbs treated with CDT alone, PMT alone and PMT combined CDT, the rate of valve reflux was 38.9% (14/36), 33.3% (5/15), and 55.6% (5/9) respectively (P=0.077).ConclusionIn the patients suffering acute DVT, PMT or PMT combined CDT does not hamper valve function compared with CDT alone.
Objective
To investigate the short-term result of catheter directed thrombolysis (CDT) in treatment of acute deep venous thrombosis (DVT) in lower extremity.
Methods
A total of 289 cases of acute DVT in lower extremity who got treatment in Nanjing Drum Tower Hospital Group Suqian City People’s Hospital and Xuzhou Central Hospital from March 2013 to December 2014 were enrolled prospectively, and of them, 125 cases of system thrombolysis (ST) group underwent ST, 164 cases of CDT group underwent inferior vena cava filter placement (IVCF)+CDT. Clinical effect was compared between the 2 groups.
Results
Clinical symptoms of all cases were obviously relieved, and limb swelling was significantly reduced. Of the CDT group, 73 cases presented iliac vein compression syndrome (IVCS), and 43 cases of them underwent the percutaneous transluminal angioplasty and stent implantation. In CDT group, there was 1 case complicated by catheter displacement, 10 cases suffered from puncture site ecchymosis, 3 cases suffered from hematuria. In ST group, there was 1 case suffered from pulmonary embolism (PE), 14 cases suffered from bleeding gums, 22 cases suffered from hematuria, 3 cases suffered from skin and mucosa petechia, and 2 cases suffered from melena (didn’t need transfusion). The morbidity of ST group was higher than that of CDT group (P=0.002). There were 18 cases suffered from recurrence in ST group, 15 cases suffered from recurrence in CDT group, but there was no significant difference in the recurrence rate between the 2 groups (P=0.786). In addition, the dosage of urokinase, thrombolysis time, blood vessel patency score, thigh circumference after treatment, and calf circumference after treatment in ST group were all higher than those of CDT group (P<0.050), but the Villalta score in ST group was lower than that of CDT group (P<0.001). There was no significant difference in hospital stay (P=0.383).
Conclusion
For acute DVT in lower extremity, CDT has a superior short-term outcome with safety and feasibility.
ObjectiveTo compare the differences of incidence rate and severity of postthrombotic syndrome (PTS) of patients with lower extremity deep venous thrombosis (DVT) treated by catherter-directed thrombolysis (CDT) or via peripheral vein thrombolysis (PVT).MethodsThe patients with unilateral lower extremity DVT who had received anticoagulant and thrombolytic therapy in the Nanchong Central Hospital from January 2012 to January 2015 were collected. These patients were divided into CDT group and PVT group according to the different thrombolysis methods, and then the thrombolytic rates, thrombolytic complications, and the incidence rate and severity of PTS of 5-year follow up results were calculated and compared.ResultsA total of 137 cases of DVT were collected, 79 in the CDT group and 58 in the PVT group. There were no significant differences in the gender, age, course of disease, thrombus type, and other baseline data between the two groups (P>0.05). The thrombolytic rate of the CDT group was (78.6±16.3)% and PVT group was (27.3±12.1)%, the difference was significant (t=21.14, P<0.001). The rate of thrombolytic complications between the PVT group and CDT group had no statistical significance (32.8% versus 21.5%, χ2=2.18, P=0.134). The 5-year follow up was completed in 116 cases, 74 patients from the CDT group and 42 patients from the PVT group respectively, the result showed that the incidence rate of the PTS in the CDT group was lower than that in the PVT group (35.1% versus 88.1%, χ2=30.28, P<0.001), and theseverity of PTS in the CDT group was milder than that in the PVT group too (Z=16.52,P<0.001).ConclusionFrom the results of this study, CDT is able to increase thrombolytic rate and effectively reduce incidence rate and severity of PTS.
