Neurology:静脉溶栓桥接血管内治疗后的罕见并发症

2018-02-16 杨中华 脑血管病及重症文献导读

53岁,男性。既往服用ACEI降压药物。

53岁,男性。

既往服用ACEI降压药物。

因左侧偏瘫就诊,NIHSS 23。

MRA显示右侧MCA近端闭塞(下图):



溶栓30分钟后,患者出现口舌水肿。2h后,机械取栓结束后,患者发生痛性腹部水肿,给予艾替班特后好转(下图)。

下图,左侧上下唇血管源性水肿(A);痛性腹部水肿(C);艾替班特治疗后恢复正常(B和D):



缓激肽介导血管源性水肿是rtPA的并发症,通常表现为口舌水肿,ACEI药物会增加这种风险。

研究者推测机械性血栓切除术扮演了一种物理性应激作用,是腹部水肿的触发因素。

备注:艾替班特是一种强力的选择性的缓激肽B2受体及拮抗剂,艾替班特通过抑制与HAE的栓塞局部肿胀、炎症、疼痛症状有关的缓激肽的影响而治疗急性HAE的栓塞局部肿胀。

原始出处:
Charline Benoit, et al. Orolingual and abdominal angioedema post thrombolysis and thrombectomy. Neurology.2018 Jan 16;90(3):140-141.doi:10.1212/WNL.0000000000004834.

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    2018-08-08 yinhl1978
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    2018-05-06 丁鹏鹏
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    2018-04-24 fusion
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    2018-02-18 syscxl
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    2018-02-17 清风拂面

    谢谢分享学习

    0

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    2018-02-16 有备才能无患

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