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- W2415212597 abstract "L’utilisation de la thrombolyse intraveineuse dans le traitement en urgence des infarctus cérébraux est contre-indiquée chez les patients porteurs d’une malformation vasculaire cérébrale, qu’elle soit antérieurement connue ou découverte fortuitement lors de l’examen d’imagerie cérébrale initiale. Cette exclusion résulte du risque théorique de saignement ou de rupture de la malformation au cours ou au décours de la thrombolyse. Ce risque semble cependant faible en pratique clinique. À partir de deux observations et des données de la littérature, nous proposons une évaluation des risques hémorragiques induits par le traitement selon le type de malformation (anévrisme, malformation artérioveineuse, cavernome et fistule) et les alternatives thérapeutiques. Intravenous recombinant tissue plasminogen activator for acute ischemic stroke is contraindicated in patients harboring an asymptomatic intracranial vascular malformation, whether it is incidentally discovered at the time of the initial cerebral imaging or previously known. Because thrombolysis is associated with a risk of serious intracerebral hemorrhage, it is theoretically possible that this treatment increases the risk of bleeding or rupture of these malformations. However, this risk seems very low in clinical practice. We report two cases, one with a probable brainstem cavernous malformation treated with alteplase for a supratentorial ischemic stroke who developed just after treatment a fatal brainstem hemorrhage, and another one with asymptomatic dural arteriovenous fistula, treated by endovascular thrombectomy solely. This approach was safe and effective, and the patient had an endovascular embolization of the fistula one month later as it became symptomatic. Based on the literature, we discuss the bleeding risk of asymptomatic intracranial vascular malformations in acute ischemic stroke patients treated with alteplase, depending on the type of malformation (intracranial aneurysm, arteriovenous and cavernous malformation or fistula), and the alternative therapeutic options." @default.
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- W2415212597 date "2014-06-01" @default.
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- W2415212597 title "Malformation vasculaire cérébrale découverte dans le bilan pré-thrombolyse d’un infarctus cérébral. Impact sur la décision thérapeutique" @default.
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- W2415212597 doi "https://doi.org/10.1016/j.neurol.2014.03.003" @default.
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