Combined full-dose IV and endovascular thrombolysis in acute ischaemic stroke

被引:26
作者
Bhatia, Rohit [1 ]
Shobha, Nandavar [8 ]
Menon, Bijoy K. [2 ]
Bal, Simerpreet P. [2 ]
Kochar, Puneet [3 ]
Palumbo, Vanessa [7 ]
Wong, John H. [2 ,3 ,4 ]
Morrish, William F. [2 ,3 ]
Hudon, Mark E. [2 ,3 ]
Hu, William [2 ,3 ]
Coutts, Shelagh B. [2 ,3 ]
Barber, Phillip A. [2 ]
Watson, Tim [2 ]
Goyal, Mayank [2 ,3 ]
Demchuk, Andrew M. [2 ]
Hill, Michael D. [2 ,3 ,5 ,6 ]
机构
[1] All India Inst Med Sci, Dept Neurol, New Delhi, India
[2] Univ Calgary, Foothills Hosp, Hotchkiss Brain Inst, Calgary Stroke Program,Dept Clin Neurosci, Calgary, AB T2N 2T9, Canada
[3] Univ Calgary, Foothills Hosp, Hotchkiss Brain Inst, Dept Radiol,Calgary Stroke Program, Calgary, AB T2N 2T9, Canada
[4] Univ Calgary, Foothills Hosp, Hotchkiss Brain Inst, Dept Neurosurg,Calgary Stroke Program, Calgary, AB T2N 2T9, Canada
[5] Univ Calgary, Foothills Hosp, Hotchkiss Brain Inst, Dept Med,Calgary Stroke Program, Calgary, AB T2N 2T9, Canada
[6] Univ Calgary, Foothills Hosp, Hotchkiss Brain Inst, Dept Community Hlth Sci,Calgary Stroke Program, Calgary, AB T2N 2T9, Canada
[7] Univ Florence, Dept Neurol & Psychiat Sci, I-50121 Florence, Italy
[8] Vikram Hosp, Bhagwan Mahaveer Jain Hosp, Vagus Superspecial Hosp, Bangalore Neuro Ctr, Bangalore, Karnataka, India
关键词
endovascular therapy; intra-arterial thrombolysis; stroke; thrombolysis; TISSUE-PLASMINOGEN ACTIVATOR; CEREBRAL-ARTERY OCCLUSION; INTRAARTERIAL THROMBOLYSIS; INTERVENTIONAL MANAGEMENT; MECHANICAL THROMBECTOMY; CONTROLLED-TRIAL; MERCI TRIAL; RECANALIZATION; THERAPY; PROUROKINASE;
D O I
10.1111/j.1747-4949.2012.00890.x
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background There is an increasing trend to treating proximal vessel occlusions with intravenous-inter-arterial (IV-IA) thrombolysis. The best dose of IV tissue plasminogen activator (tPA) remains undetermined. We compared the combination of full-dose IV recombinant tissue plasminogen activator (rtPA) and IA thrombolytic therapy to IA therapy. Methods Between 2002 and 2009, we reviewed our computed tomographic angiography database for patients who received full-dose intravenous rtPA and endovascular therapy or endovascular therapy alone for acute ischaemic stroke treatment. Details of demographics, risk factors, endovascular procedure, and symptomatic intracranial haemorrhage were noted. Modified Rankin Scale <= 2 at three-months was used as good outcome. Recanalization was defined as Thrombolysis in Myocardial Ischaemia 2-3 flow on angiography. Results Among 157 patients, 104 patients received IV-IA treatment and 53 patients underwent direct IA therapy. There was a higher recanalization rate with IV-IA therapy compared with IA alone (71% vs. 60%, P < 0.21) which was driven by early recanalization after IV rtPA. Mortality and independent outcome were comparable between the two groups. Symptomatic intracranial haemorrhage occurred in 8% of patients (12% in the IA group, 7% in the IV-IA group) but was more frequent as the intensity of intervention increased from device alone to thrombolytic drug alone to device plus thrombolytic drug(s). Recanalization was a strong predictor of reduced mortality risk ratio (RR) 0.48 confidence interval(95) 0.27-0.84) and favourable outcome (RR 2.14 confidence interval(95) 1.3-3.5). Conclusions Combined IV-IA therapy with full-dose intravenous rtPA was safe and results in good recanalization rates without excess symptomatic intracranial haemorrhage. Testing of full-dose IV tPA followed by endovascular treatment in the IMS3 trial is justified.
引用
收藏
页码:974 / 979
页数:6
相关论文
共 35 条
[1]  
[Anonymous], N ENGL J MED
[2]  
[Anonymous], STROKE
[3]  
[Anonymous], STROKE
[4]  
[Anonymous], STROKE
[5]   Recanalisation of middle cerebral artery occlusion after intra-arterial thrombolysis: different recanalisation grading systems and clinical functional outcome [J].
Arnold, M ;
Nedeltchev, K ;
Remonda, L ;
Fischer, U ;
Brekenfeld, C ;
Keserue, B ;
Schroth, G ;
Mattle, HP .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 2005, 76 (10) :1373-1376
[6]   Intra-arterial thrombolysis in 100 patients with acute stroke due to middle cerebral artery occlusion [J].
Arnold, M ;
Schroth, G ;
Nedeltchev, K ;
Loher, T ;
Remonda, L ;
Stepper, F ;
Sturzenegger, M ;
Mattle, HP .
STROKE, 2002, 33 (07) :1828-1833
[7]   Intra-Arterial Thrombolysis Within Three Hours of Stroke Onset in Middle Cerebral Artery Strokes [J].
Bourekas, Eric C. ;
Slivka, Andrew ;
Shah, Rajul ;
Mohammad, Yousef ;
Slone, H. Wayne ;
Kehagias, Dimitris T. ;
Suarez, Jose ;
Sunshine, Jeffrey ;
Zaidat, Osama O. ;
Tarr, Robert ;
Landis, Dennis M. ;
Suri, M. Fareed K. ;
Qureshi, Adnan I. .
NEUROCRITICAL CARE, 2009, 11 (02) :217-222
[8]   Endovascular Interventions following Intravenous Thrombolysis May Improve Survival and Recovery in Patients with Acute Ischemic Stroke: A Case-Control Study [J].
Burns, T. C. ;
Rodriguez, G. J. ;
Patel, S. ;
Hussein, H. M. ;
Georgiadis, A. L. ;
Lakshminarayan, K. ;
Qureshi, A. I. .
AMERICAN JOURNAL OF NEURORADIOLOGY, 2008, 29 (10) :1918-1924
[9]   PROACT: A phase II randomized trial of recombinant pro-urokinase by direct arterial delivery in acute middle cerebral artery stroke [J].
del Zoppo, GJ ;
Higashida, RT ;
Furlan, AJ ;
Pessin, MS ;
Rowley, HA ;
Gent, M .
STROKE, 1998, 29 (01) :4-11
[10]   Intracerebral haemorrhage after thrombolysis for acute ischaemic stroke: an update [J].
Derex, L. ;
Nighoghossian, N. .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 2008, 79 (10) :1093-1099