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タイトル: | Acute ischemic stroke as a complication of Stanford type A acute aortic dissection: a review and proposed clinical recommendations for urgent diagnosis |
著者: | Koga, Masatoshi Iguchi, Yasuyuki Ohara, Tomoyuki Tahara, Yoshio Fukuda, Tetsuya Noguchi, Teruo Matsuda, Hitoshi Minatoya, Kenji Nagatsuka, Kazuyuki Toyoda, Kazunori |
著者名の別形: | 湊谷, 謙司 |
キーワード: | Intravenous rt-PA therapy Chest or back pain Blood pressure laterality Carotid ultrasonography D-dimer |
発行日: | Aug-2018 |
出版者: | Springer Nature |
誌名: | General Thoracic and Cardiovascular Surgery |
巻: | 66 |
号: | 8 |
開始ページ: | 439 |
終了ページ: | 445 |
抄録: | Background: Stanford type A acute aortic dissection requires emergency surgery. Because patients with ischemic stroke as a complication of Stanford type A acute aortic dissection do not often complain of chest or back pain, probably due to consciousness disturbance, amnesia, or aphasia, a fatal course following inappropriate intravenous rt-PA therapy and delay of appropriate surgical treatment sometimes occur. Review and prospected recommendations: When treating any suspected stroke patients, emergency services and initial urgent care doctors should always suspect aortic dissection. Even in the absence of chest or back pain, the initial urgent care doctor needs to immediately perform chest contrast CT if suspecting aortic dissection from blood pressure laterality or upper mediastinal widening on chest X-ray. Whenever aortic dissection cannot be ruled out from initial clinical information, the initial urgent care doctor should evaluate the common carotid artery (CCA). Dissection extension to the CCA or flow abnormality of the CCA is often detected if aortic dissection is a cause of ischemic stroke or transient ischemic attack. Head CT or MRI including vascular imaging is preferable. D-dimer should be measured in hospitals where available. As soon as aortic dissection is identified, the initial urgent care doctor needs to consult with cardiovascular surgeons or cardiologists for appropriate treatment. |
著作権等: | © The Author(s) 2018 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
URI: | http://hdl.handle.net/2433/233091 |
DOI(出版社版): | 10.1007/s11748-018-0956-4 |
PubMed ID: | 29948797 |
出現コレクション: | 学術雑誌掲載論文等 |
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