Intraarterial Thrombolysis as Rescue Therapy for Large Vessel Occlusions
| Autor: | Roberta Novakovic, Peng R Chen, Hashem Shaltoni, Italo Linfante, Thanh N. Nguyen, Ansaar T Rai, Osama O. Zaidat, Coleman O. Martin, Aamir Badruddin, Gavin W. Britz, Mouhammad A. Jumaa, Nils Mueller-Kronast, M. Asif Taqi, Syed F Zaidi, Hormozd Bozorgchami, Michael G. Abraham, Andrew R. Xavier, Joey English, Raul G Nogueira, Franklin A. Marden, Alicia C. Castonguay, Michael T. Froehler, Ritesh Kaushal, William E. Holloway, Albert J Yoo, Guilherme Dabus, Vallabh Janardhan, Tim W. Malisch, Ashish Nanda, Rishi Gupta, Alex Bou Chebl |
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| Rok vydání: | 2019 |
| Předmět: |
Advanced and Specialized Nursing
education.field_of_study medicine.medical_specialty Solitaire Cryptographic Algorithm Cerebral infarction business.industry medicine.medical_treatment Population Context (language use) Thrombolysis medicine.disease Revascularization Modified Rankin Scale Internal medicine medicine Cardiology Neurology (clinical) Cardiology and Cardiovascular Medicine business education Stroke |
| Zdroj: | Stroke. 50:1003-1006 |
| ISSN: | 1524-4628 0039-2499 |
| DOI: | 10.1161/strokeaha.118.024442 |
| Popis: | Background and Purpose— Mechanical thrombectomy (MT) devices have led to improved reperfusion and clinical outcomes in acute ischemic stroke patients with emergent large vessel occlusions; however, less than one-third of patients achieve complete reperfusion. Use of intraarterial thrombolysis in the context of MT may provide an opportunity to enhance these results. Here, we evaluate the use of intraarterial rtPA (recombinant tissue-type plasminogen activator) as rescue therapy (RT) after failed MT in the North American Solitaire Stent-Retriever Acute Stroke registry. Methods— The North American Solitaire Stent-Retriever Acute Stroke registry recruited sites within North America to submit data on acute ischemic stroke patients treated with the Solitaire device. After restricting the population of 354 patients to use of RT and anterior emergent large vessel occlusions, we compared patients who were treated with and without intraarterial rtPA after failed MT. Results— A total of 37 and 44 patients was in the intraarterial rtPA RT and the no intraarterial rtPA RT groups, respectively. Revascularization success (modified Thrombolysis in Cerebral Infarction ≥2b) was achieved in more intraarterial rtPA RT patients (61.2% versus 46.6%; P =0.13) with faster times to recanalization (100±85 versus 164±235 minutes; P =0.36) but was not statistically significant. The rate of symptomatic intracranial hemorrhage (13.9% versus 6.8%; P =0.29) and mortality (42.9% versus 44.7%; P =0.87) were similar between the groups. Good functional outcome (modified Rankin Scale score of ≤2) was numerically higher in intraarterial rtPA patients (22.9% versus 18.4%; P =0.64). Further restriction of the RT population to M1 occlusions only and time of onset to groin puncture ≤8 hours, resulted in significantly higher successful revascularization rates in the intraarterial rtPA RT cohort (77.8% versus 38.9%; P =0.02). Conclusions— Intraarterial rtPA as RT demonstrated a similar safety and clinical outcome profile, with higher reperfusion rates achieved in patients with M1 occlusions. Prospective studies are needed to delineate the role of intraarterial thrombolysis in MT. |
| Databáze: | OpenAIRE |
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