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Research ArticleINTERVENTIONAL

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

R.M. Sugg, E.A. Noser, H.M. Shaltoni, N.R. Gonzales, M.S. Campbell, R. Weir, E.D. Cacayorin and J.C. Grotta
American Journal of Neuroradiology April 2006, 27 (4) 769-773;
R.M. Sugg
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E.A. Noser
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H.M. Shaltoni
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N.R. Gonzales
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M.S. Campbell
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R. Weir
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E.D. Cacayorin
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J.C. Grotta
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    Fig 1.

    Initial and postprocedural angiography in a 58-year-old woman treated with UK (initial TICI, 0; final TICI, 2c) and in a 71-year-old treated with RP (initial TICI, 0; final TICI, 2c).

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    Fig 2.

    Recanalization, intracerebral hemorrhage (ICH), mortality, and outcome in treatment groups.

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    Table 1:

    Angiographic characteristics of treatment groups

    Reteplase (n = 33)Urokinase (n = 22)
    Mean age, y (median, range)63 ± 13 (64, 36–88)60 ± 15 (62, 25–83)
    Median NIHSS (range)16 (5–25, 81% ≥10)17 (6–38, 85% ≥10)
    Occlusion territory
        ICA7 (21%)4 (18%)
            Location4 distal (3 “T” occlusions), 3 proximal3 distal (3 “T” occlusions), 1 proximal
            Etiology3 thrombotic, 3 embolic, 1 unknown2 embolic, 2 unknown
        MCA17 (52%)9 (41%)
            Location10 M-1, 7 M-26 M-1, 3 M-2
            Etiology5 thrombotic, 11 embolic, 1 unknown4 thrombotic, 5 embolic
        BA9 (27%)9 (41%)
            Location6 proximal, 2 middle, 1 distal6 proximal, 1 middle, 2 distal
            Etiology4 thrombotic, 4 embolic, 1 unknown1 thrombotic, 8 embolic
    Mean, median, and range of time from stroke onset to IA treatment (minutes)333 + 230 (285, 148–1195)343 + 169 (305, 133–720)
    Mean total IA thrombolytic dose2.5 ± 1.36 mg (2, 1–6)690,000 ± 562,000 U (575,000, 50,000–1,500,000)
    Mechanical thrombolysis
        Simple wire6 (1 BA, 4 MCA, 1 ICA)3 (1 MCA, 2 ICA)
        PTA11 (2 BA, 8 MCA, 1 ICA)0
        PTA + stent2 (1 MCA, 1 ICA)2 (1 BA, 1 ICA)
    • Note:—NIHSS indicates National Institutes of Health Stroke Scale; IA, intra-arterial; PTA, percutaneous transluminal angioplasty; BA, basilar artery; MCA, middle cerebral artery; ICA, internal carotid artery.

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    Table 2:

    Immediate recanalization in treatment groups

    Reteplase (n = 33)Urokinase (n = 22)
    Immediate recanalization (TICI ≥ 2)*8264
    Final TICI
        01527
        139
        2a2114
        2b4323
        2c1527
        330
    Immediate recanalization by artery
        ICA7125
        MCA7667
        BA10078
    • Note:—TICI indicates thrombolysis in cerebral ischemia scale; ICA, internal carotid artery; MCA, middle cerebral artery; BA, basilar artery.

    • * P = .129.

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American Journal of Neuroradiology: 27 (4)
American Journal of Neuroradiology
Vol. 27, Issue 4
April 2006
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Intra-Arterial Reteplase Compared to Urokinase for Thrombolytic Recanalization in Acute Ischemic Stroke
R.M. Sugg, E.A. Noser, H.M. Shaltoni, N.R. Gonzales, M.S. Campbell, R. Weir, E.D. Cacayorin, J.C. Grotta
American Journal of Neuroradiology Apr 2006, 27 (4) 769-773;

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Intra-Arterial Reteplase Compared to Urokinase for Thrombolytic Recanalization in Acute Ischemic Stroke
R.M. Sugg, E.A. Noser, H.M. Shaltoni, N.R. Gonzales, M.S. Campbell, R. Weir, E.D. Cacayorin, J.C. Grotta
American Journal of Neuroradiology Apr 2006, 27 (4) 769-773;
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