Effectiveness of Low-Dose Intravenous Tissue Plasminogen Activator before Stent Retriever or Aspiration Mechanical Thrombectomy

Autor: Michihiro Hayasaka, Sumio Suda, Kouichi Ebihara, Wataru Nishino, Tatsuma Matsuda, Yosuke Tajima, Masaaki Kubota
Rok vydání: 2019
Předmět:
Male
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Suction
Time-to-Treatment
030218 nuclear medicine & medical imaging
Disability Evaluation
03 medical and health sciences
0302 clinical medicine
Fibrinolytic Agents
Japan
Risk Factors
Modified Rankin Scale
medicine
Humans
Thrombolytic Therapy
Radiology
Nuclear Medicine and imaging
Intravenous tissue plasminogen activator
Infusions
Intravenous
Stroke
Aged
Retrospective Studies
Thrombectomy
Stent retriever
Aged
80 and over
business.industry
Endovascular Procedures
Low dose
Retrospective cohort study
Recovery of Function
Thrombolysis
medicine.disease
Surgery
Mechanical thrombectomy
Treatment Outcome
Tissue Plasminogen Activator
030220 oncology & carcinogenesis
Female
Stents
Cardiology and Cardiovascular Medicine
business
Intracranial Hemorrhages
Vascular Access Devices
Zdroj: Journal of Vascular and Interventional Radiology. 30:134-140
ISSN: 1051-0443
Popis: Purpose To determine whether thrombolysis with a lower dose of intravenous recombinant tissue plasminogen activator before mechanical thrombectomy is beneficial for functional outcomes compared with mechanical thrombectomy alone. Materials and Methods Data for 100 Japanese patients who underwent mechanical thrombectomy between July 2014 and November 2017 were retrospectively reviewed. These patients were divided into groups according to whether they received intravenous thrombolysis before mechanical thrombectomy, and outcomes were compared. Favorable outcome was defined as a modified Rankin scale score ≤ 2 at 3 months after treatment. Results Thirty-four patients for the thrombolysis group and 66 patients for the thrombectomy-only group were identified. The thrombolysis and nonthrombolysis groups did not differ significantly in baseline characteristics (mean age, 74.3 y vs 75.7 y [P = .485]; mean preoperative National Institute Health Stroke Scale score, 19.8 vs 19.6 [P = .825]). There were no significant differences in the times required for, or the rates of, successful recanalization. However, the thrombolysis group had a higher rate of complete recanalization (67.6% vs 43.9%; P = .041). Postoperative symptomatic intracranial hemorrhage was not significantly different between groups. Favorable outcomes were observed in 73.5% of patients in the thrombolysis group and 51.5% in the nonthrombolysis group (P = .028). Conclusions This single-center retrospective study shows that lower-dose intravenous thrombolysis improves the outcomes of mechanical thrombectomy for Japanese patients with acute anterior-circulation stroke treated within 4.5 hours of onset.
Databáze: OpenAIRE
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