Advanced

AJNR - American Journal of Neuroradiology

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Sugg, R.M. Articles by Grotta, J.C. Search for Related Content PubMed PubMed Citation Articles by Sugg, R.M. Articles by Grotta, J.C.

American Journal of Neuroradiology 27:769-773, April 2006
© 2006 American Society of Neuroradiology

INTERVENTIONAL

Intra-Arterial Reteplase Compared to Urokinase for Thrombolytic Recanalization in Acute Ischemic Stroke

R.M. Sugg^a, E.A. Noser^a, H.M. Shaltoni^a, N.R. Gonzales^a, M.S. Campbell^c, R. Weir^b, E.D. Cacayorin^b and J.C. Grotta^a

^a Department of Neurology, University of Texas—Houston Medical School, Houston, Tex
^b Department of Radiology, University of Texas—Houston Medical School, Houston, Tex
^c Alabama Neurological Institute, Birmingham, Ala

Address correspondence to Rebecca M Sugg, MD, Departments of Neurology and Radiology, University of Alabama at Birmingham, WP 155, 619 19th St South, Birmingham, AL 35249-6830

BACKGROUND AND PURPOSE: Reteplase (RP) and urokinase (UK) are being used "off-label" to treat acute ischemic stroke. The safety and efficacy of intra-arterial RP or UK in the treatment of acute ischemic stroke, however, has yet to be proved. We aim to evaluate the safety and efficacy of RP compared with UK in acute ischemic stroke patients with large vessel occlusion.

METHODS: Retrospective analysis was conducted of cases from a prospectively collected stroke data base on consecutive acute ischemic stroke patients with large vessel occlusion by digital subtraction angiography treated with intra-arterial RP or UK. Thrombolytic dosage, recanalization rate, intracerebral hemorrhage (ICH), mortality, and outcome were determined.

RESULTS: Thirty-three patients received RP and 22 received UK (mean doses, 2.5 ± 1.4 mg and 690,000 ± 562,000 U, respectively). Vascular occlusions included 9 basilar arteries (BAs), 7 internal carotid arteries (ICAs), and 17 middle cerebral arteries (MCAs) with RP and 9 BAs, 4 ICAs, and 9 MCAs with UK. Median baseline National Institutes of Health Stroke Scales were as follows: 16 (range, 5–25; 81% 10) with RP and 17 (range, 6–38; 85%10) with UK. Mean time from symptom onset to thrombolytic initiation: 333 ± 230 minutes with RP and 343 ± 169 minutes with UK. Recanalization rates were as follows: 82% with RP and 64% with UK (P = .13). Symptomatic ICH rates were as follows: 12% with RP and 4.5% with UK (P = .50). The mortality rate was 24% with RP and 27% with UK (P = .8).

CONCLUSION: Although limited in statistical power, our study suggests that, although IA thrombolysis with RP shows a trend for higher recanalization rates and hemorrhage rates, IA thrombolysis with RP is not significantly different in recanalization, outcome, mortality, and ICH compared with that of UK or rates reported with IA pro-UK.

This article has been cited by other articles:

				A. Ciccone, L. Valvassori, R. Gasparotti, F. Scomazzoni, E. Ballabio, and R. Sterzi Debunking 7 Myths That Hamper the Realization of Randomized Controlled Trials on Intra-Arterial Thrombolysis for Acute Ischemic Stroke Stroke, July 1, 2007; 38(7): 2191 - 2195. [Abstract] [Full Text] [PDF]

				A. C. Flint, G. R. Duckwiler, R. F. Budzik, D. S. Liebeskind, W. S. Smith, and for the MERCI and Multi MERCI Writing Committee Mechanical Thrombectomy of Intracranial Internal Carotid Occlusion: Pooled Results of the MERCI and Multi MERCI Part I Trials Stroke, April 1, 2007; 38(4): 1274 - 1280. [Abstract] [Full Text] [PDF]

				T. Tomsick TIMI, TIBI, TICI: I Came, I Saw, I Got Confused AJNR Am. J. Neuroradiol., February 1, 2007; 28(2): 382 - 384. [Full Text] [PDF]