Is IV t PA or mechanical thrombectomy safe
Is IV t. PA or mechanical thrombectomy safe in patients with known brain metastasis? Fellows name: Judy Dawod Date: 1/28/2021
• systematic literature research of electronic databases covering the period from 1990 to 2012 • 12 patients with different brain tumors who were treated with thrombolysis for different reasons • Brain tumors included 6 meningiomas, 2 glioblastomas, 1 schwannoma, 1 low-grade astrocytoma, 1 pituitary adenoma, and 1 brain tumor without furtherdetails • Intracerebral hemorrhage occurred in 1 patient (8. 3%) with a glioblastoma, and in the other 11 patients (91. 7%), no hemorrhage was documented • Thorleif Etgen et al, Thrombolysis for Ischemic Stroke in Patients with Brain Tumors, Journal of Stroke and Cerebrovascular Diseases. February 2014, Pages 361 -366
• Patients with acute ischemic stroke who received thrombolysis were identified from the 2002 -2011 USA Nationwide Inpatient Sample • Of the 124, 083 thrombolysis-treated stroke patients, 416 (0. 34%) had brain tumors. In adjusted analysis, inpatient mortality, rate of home discharge, and rate of ICH were similar between benign BTS and NBTS • Analysis of brain tumor subtypes showed that compared to NBTS, malignant BTS were independently associated with higher inhospital mortality, lower home discharge, and increased risk of ICH • Additionally, among the BTS, intraparenchymal location of tumor was associated with higher mortality and lower home discharge • Santosh B Murthy et al, In-hospital outcomes of thrombolysis for acute ischemic stroke in patients with primary brain tumors, J clin neurosci. 2015 Mar; 22(3): 474 -8
• Combined macroscopic and microscopic hemorrhage rate was 29. 2% for mixed oligodendroglioma/astrocytoma, 19. 3% for glioblastoma, 12. 5% for astrocytoma, and 2. 8% for meningioma • Among metastatic lesions, melanoma showed the highest rate of hemorrhage (50%) • Metastatic adenocarcinoma, squamous carcinoma, and anaplastic carcinoma had significantly lower bleeding rates • Although choriocarcinoma is often reported to have intratumoral hemorrhage, no cases were documented in the present study • Douglas Kondziolka, Significance of hemorrhage into brain tumors: clinicopathological study, journal of neurosurgery, dec 1987
Mechanical thrombectomy • There are many article s for MT in patient with active cancer, all showed worse outcome, less likely to be discharged home and less likely to be independent • Risk of hemorrhage was not higher for patient who have active cancer • No articles about MT in primary brain tumors or mets
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