Intra-arterial Thrombolysis for Acute Ischemic Stroke: Preliminary Experience with Platelet Glycoprotein IIb/IIIa Inhibitors as Adjunctive Therapy
| Autor: | Cameron G. McDougall, David Fiorella, Felipe C. Albuquerque, Robert F. Spetzler, Robert C. Wallace, James L. Frey, Vivek R. Deshmukh, Murray Flaster |
|---|---|
| Rok vydání: | 2005 |
| Předmět: |
Adult
Male Abciximab medicine.medical_treatment Eptifibatide Platelet Glycoprotein GPIIb-IIIa Complex Brain Ischemia Immunoglobulin Fab Fragments Mechanical Thrombolysis Angioplasty medicine Humans Thrombolytic Therapy Prospective Studies Stroke Aged Aged 80 and over Intracerebral hemorrhage business.industry Antibodies Monoclonal Tirofiban Thrombolysis Middle Aged medicine.disease Chemotherapy Adjuvant Anesthesia Acute Disease Tyrosine Female Surgery Neurology (clinical) Peptides business medicine.drug |
| Zdroj: | Neurosurgery. 56:46-55 |
| ISSN: | 1524-4040 0148-396X |
| Popis: | OBJECTIVE: To evaluate the safety profile of platelet glycoprotein IIb/IIIa inhibitors administered as adjunctive therapy to patients with large-vessel occlusion and acute ischemic stroke refractory to pharmacological thrombolysis with recombinant tissue plasminogen activator (rtPA) and mechanical disruption, balloon angioplasty, or both. METHODS: Twenty-one patients (mean age, 62 yr; range, 29–88 yr) met the following criteria: 1) large-vessel occlusion and acute ischemic stroke syndrome at presentation, 2) failure to recanalize after administration of rtPA (intra-arterial and/or intravenous) with or without mechanical thrombolysis, and 3) subsequent treatment with IIb/IIIa inhibitors (intra-arterial or intravenous). RESULTS: Eleven patients had ischemia in the dominant hemisphere, 8 in the vertebrobasilar system, and 2 in the nondominant hemisphere. Twelve patients received intravenous rtPA without significant improvement; 9 patients were not candidates for intravenous rtPA. All patients received intra-arterial rtPA. The IIb/IIIa inhibitors were administered intravenously in 3 patients, intra-arterially in 16, and both intravenously and intra-arterially in 2. Balloon angioplasty was performed in 18 patients. Complete or partial recanalization was achieved in 17 of the 21 patients. After thrombolysis, 15 improved clinically. Three patients (14%) sustained an asymptomatic intracerebral hemorrhage after thrombolytic therapy. No patient was clinically worse after intervention. At last follow-up (mean, 8.5 mo), 13 patients were functionally independent (modified Rankin score, 0–3) and 8 were disabled or dead. CONCLUSION: IIb/IIIa inhibitors are an alternative for achieving recanalization. The risk of hemorrhage may be low. As part of an escalating protocol that includes pharmacological and mechanical thrombolysis, IIb/IIIa inhibitors may improve clinical outcomes. |
| Databáze: | OpenAIRE |
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