BRAFMutation in Metastatic Colorectal Cancer

作者：Jolien Tol, Irıs D. Nagtegaal, Cornelis J.A. Punt · 发表于：New England Journal of Medicine · 年份：2009 · DOI：10.1056/nejmc0904160 · 被引用次数：520 · 研究领域：Colorectal Cancer Treatments and Studies、Hepatocellular Carcinoma Treatment and Prognosis、Genetic factors in colorectal cancer

To the Editor: Moyamoya disease presents most often as a transient ischemic attack or stroke.Apart from surgical revascularization procedures, medical therapeutic measures such as antiplatelet agents and even anticoagulation have been used for stroke prevention.In completed stroke, as confirmed by means of diffusion-weighted magnetic resonance imaging, antiplatelet agents should be administered to reduce the formation of microthrombi at the site of the stenosis.We would like to raise a question about thrombolytic therapy with the use of tissue plasminogen activator (t-PA), which is today an accepted treatment for ischemic strokes.The threat of hemorrhage from the fragile collateral vessels that develop as compensation for carotid artery stenosis might prevent application of this effective therapy.Have there been any reports about stroke in patients with moyamoya disease who were treated with t-PA, perhaps in patients in whom the diagnosis of the underlying vasculopathy was revealed subsequently?Should moyamoya disease be considered to be a contraindication for t-PA administration?