Dramatic thrombolysis after rapid injection of tissue plasminogen activator: A case report

We report a case of efficient recanalization of large arterial occlusion after rapid injection of rt-PA. Patient concerns: A 78-year-old man was admitted with right-sided hemiplegia and global aphasia that occurred an hour ago. Diagnoses: His brain computed tomography (CT) revealed no hemorrhage, suggesting cerebral infarction. Interventions: Ten percent of a total rt-PA dose was injected over 1 minute promptly. The remainder of rt-PA was designed to be infused for 60 minutes. Unexpectedly, during the study of CT angiography, administration of rt-PA was completed within 5 minutes. CT angiography showed occlusion from carotid bifurcation to the middle cerebral artery. Outcomes: After 2 hours of rt-PA administration, the patient began to regain strength in his right arm and leg. By the next day, he had only mild dysarthria and aphasia. Follow-up CT angiography revealed recanalized internal cervical artery and severe residual stenosis with a plaque. He was discharged without any neurologic symptoms. Lessons: The infusion protocol of rt-PA administration is established in 1995 and has not changed. Successful recanalization of long segmental large vessel occlusion with only intravenous rt-PA is relatively low. In our case, a high concentration of rt-PA may have influenced the successful dissemination of large thrombus in the whole internal cervical artery. Our case is of significance as it raises the question of unanswered efficacy of diverse injection protocol ac...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

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Publication date: Available online 4 April 2020Source: Radiation Physics and ChemistryAuthor(s): R.S. Omar, S. Hashim, S.K. Ghoshal, D.A. Bradley, N.D. Shariff
Source: Radiation Physics and Chemistry - Category: Physics Source Type: research
Authors: Wan Q, Qian S, Huang Y, Zhang Y, Peng Z, Li Q, Shu B, Zhu L, Wang M Abstract Cardiovascular disease is the number one cause of human morbidity and mortality worldwide. Although cholesterol-lowering drugs, including statins and recently approved PCSK9 inhibitors, together with antithrombotic drugs have been historically successful in reducing the occurrence of coronary artery disease (CAD), the high incidence of CAD remains imposing the largest disease burden on our healthcare systems. We reviewed cardiovascular drugs recently approved or under clinical development, with a particular focus on their pharmaco...
Source: Advances in Experimental Medicine and Biology - Category: Research Tags: Adv Exp Med Biol Source Type: research
Authors: Li T, Yuan D, Yuan J Abstract Thrombosis, the localized clotting of blood that affects arterial or venous circulation, is one of the leading causes of death worldwide. Arterial thrombosis is commonly initiated by vascular endothelial injury, while venous thrombosis mainly stems from blood stasis. Despite these differences, platelet adhesion, activation and aggregation, and fibrin formation as a result of coagulation constitute the fundamental processes of thrombus formation. Antithrombotic drugs permitted on the clinical currently can dramatically reduce major adverse cardiovascular events; however, they c...
Source: Advances in Experimental Medicine and Biology - Category: Research Tags: Adv Exp Med Biol Source Type: research
Authors: Gu D, Qu J, Zhang H, Zheng Z Abstract Coronary revascularization is the most important strategy for coronary artery disease. This review summarizes the current most prevalent approaches for coronary revascularization and discusses the evidence on the mechanisms, indications, techniques, and outcomes of these approaches. Targeting coronary thrombus, fibrinolysis is indicated for patients with diagnosed myocardial infarction and without high risk of severe hemorrhage. The development of fibrinolytic agents has improved the outcomes of ST-elevation myocardial infarction. Percutaneous coronary intervention has...
Source: Advances in Experimental Medicine and Biology - Category: Research Tags: Adv Exp Med Biol Source Type: research
Authors: Shao C, Wang J, Tian J, Tang YD Abstract In most developed countries, coronary artery disease (CAD), mostly caused by atherosclerosis of coronary arteries, is one of the primary causes of death. From 1990s to 2000s, mortality caused by acute MI declined up to 50%. The incidence of CAD is related with age, gender, economic, etc. Atherosclerosis contains some highly correlative processes such as lipid disturbances, thrombosis, inflammation, vascular smooth cell activation, remodeling, platelet activation, endothelial dysfunction, oxidative stress, altered matrix metabolism, and genetic factors. Risk factors ...
Source: Advances in Experimental Medicine and Biology - Category: Research Tags: Adv Exp Med Biol Source Type: research
We describe the case of a 39-year-old male, who presented to our emergency department after a one-day history of headache and vomiting, with associated sudden onset posterior neck pain and cerebellar signs following a massage. Computed tomography angiogram and brain demonstrated bilateral vertebral artery dissection and cerebellar stroke. He was admitted to hospital for monitoring and conservative management with antiplatelet therapy, resulting in a good outcome. This is the first reported case of bilateral vertebral artery dissection and stroke to be associated with massage. This case also suggests, unlike many reports in...
Source: New Zealand Medical Journal - Category: General Medicine Tags: N Z Med J Source Type: research
We report a very rare case of a 67-year-old male with the presence of a common hepatic artery (CHA) arising from the left gastric artery (LGA) in association with a presence of a gastro-splenic trunk (GST), found incidentally on multidetector computed tomography (MDCT) angiography, used to investigate peripheral vascular disease. The GST arises from the anterior aspect of the abdominal aorta (AA), at the level of lower 1∕3 of L1 vertebral body. The GST has a slightly concave trajectory to the right, and ends dividing into splenic artery (SA) and LGA. In the initial part of its trajectory, the SA it is wedged at 180°,...
Source: Romanian Journal of Morphology and Embryology - Category: General Medicine Tags: Rom J Morphol Embryol Source Type: research
We report a rare case of a 47-year-old male patient who presented to the Emergency Unit complaining about a two weeks-long-persistent pain in the upper abdomen and biliary vomiting. The medical history included alcohol abuse. Several days prior to the onset of these symptoms, the patient has noticed the occurrence of a nodular inflammatory lesion of 5∕3 cm on the right calf (this makes the case even rarer). Based on clinical aspect and high levels of pancreatic enzymes, acute pancreatitis was diagnosed. Contrast-enhanced abdominal computed tomography (CT) revealed a cystic pancreatic mass and dilated intrahepatic biliary...
Source: Romanian Journal of Morphology and Embryology - Category: General Medicine Tags: Rom J Morphol Embryol Source Type: research
We report a large-cell adenocarcinoma of the lung in a tobacco smoker with classical superior vena cava syndrome and digital clubbing. Computed tomography and nuclear magnetic resonance revealed the involvement of the vena cava and metastases in the left adrenal gland and central nervous system. Biopsy samples of the mass yielded the diagnosis. The patient underwent a schedule of palliative chemotherapy and brain radiotherapy. PMID: 32239113 [PubMed - in process]
Source: Romanian Journal of Morphology and Embryology - Category: General Medicine Tags: Rom J Morphol Embryol Source Type: research
Authors: Bolintineanu LA, Costea AN, Iacob N, Pusztai AM, Pleş H, Matusz P Abstract The authors report the case of a 53-year-old male found to have an extremely rare case of a triple anatomical variation highlighted by multidetector computed tomography (MDCT) angiography, with the presence of a hepato-spleno-mesenteric trunk (HSMT) in association with an accessory left hepatic artery (ALHA) and a common trunk origin of right (RIPA) and left (LIPA) inferior phrenic arteries from left gastric artery (LGA) arising independently from the abdominal part of aorta (AA). The HSMT with an endoluminal diameter of 10.9 mm at...
Source: Romanian Journal of Morphology and Embryology - Category: General Medicine Tags: Rom J Morphol Embryol Source Type: research
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