Advanced

AJNR - American Journal of Neuroradiology

Published ahead of print on September 10, 2008
doi: 10.3174/ajnr.A1236

This Article Figures Only Full Text Full Text (PDF) Supplemental Online Table All Versions of this Article: ajnr.A1236v1 29/10/1918    most recent 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 Burns, T.C. Articles by Qureshi, A.I. Search for Related Content PubMed PubMed Citation Articles by Burns, T.C. Articles by Qureshi, A.I.

American Journal of Neuroradiology 29:1918-1924, November-December 2008
© 2008 American Society of Neuroradiology

INTERVENTIONAL

Endovascular Interventions following Intravenous Thrombolysis May Improve Survival and Recovery in Patients with Acute Ischemic Stroke: A Case-Control Study

T.C. Burns^a, G.J. Rodriguez^a, S. Patel^a, H.M. Hussein^a, A.L. Georgiadis^a, K. Lakshminarayan^a and A.I. Qureshi^a

^a From the Zeenat Quereshi Stroke Research Center, University of Minnesota, Minneapolis, Minn

Please address correspondence to Gustavo J. Rodriguez, MD, Zeenat Quereshi Stroke Research Center, University of Minnesota, 12-100 PWB, 516 Delaware St SE, Minneapolis, MN 55455; e-mail: rodri218{at}umn.edu

BACKGROUND AND PURPOSE: Since the introduction of recombinant tissue plasminogen activator (rtPA) into clinical practice in the mid 1990s, no adjunctive treatment has further improved clinical outcomes in patients with ischemic stroke. The safety, feasibility, and efficacy of combining intravenous (IV) rtPA with endovascular interventions has been described; however, no direct comparative study has yet established whether endovascular interventions after IV rtPA are superior to IV rtPA alone. A retrospective case-control study was designed to address this issue.

MATERIALS AND METHODS: Between 2003 and 2006, 33 consecutive patients with acute ischemic stroke and National Institutes of Health Stroke Scale (NIHSS) scores 10 were treated with IV rtPA in combination with endovascular interventions (IV plus intervention) at a tertiary care facility. Outcomes were compared with a control cohort of 30 consecutive patients treated with IV rtPA (IV only) at a comparable facility where endovascular interventions were not available.

RESULTS: Baseline parameters were similar between the 2 groups. We found that the IV-plus-intervention group experienced significantly lower mortality at 90 days (12.1% versus 40.0%, P = .019) with a significantly greater improvement in NIHSS scores by the time of discharge or follow-up (P = .025). In the IV-plus-intervention group, patients with admission NIHSS scores between 10 and 15 and patients 80 years of age showed the greatest improvement, with a significant change of the NIHSS scores from admission (P = .00015 and P = .013, respectively).

CONCLUSIONS: In this small case-control study of patients with acute ischemic stroke and admission NIHSS scores 10, there was a suggestion of incremental clinical benefit among patients receiving endovascular interventions following standard administration of IV rtPA.

This article has been cited by other articles:

				R.G. Nogueira, A.J. Yoo, F.S. Buonanno, and J.A. Hirsch Endovascular Approaches to Acute Stroke, Part 2: A Comprehensive Review of Studies and Trials AJNR Am. J. Neuroradiol., May 1, 2009; 30(5): 859 - 875. [Abstract] [Full Text] [PDF]