Abstract
BACKGROUND AND PURPOSE: IV administration of tPA is accepted as a standard treatment for acute cerebral ischemia, but the clinical outcomes cannot be guaranteed in patients who are not recanalized after IV-tPA and in those who are not eligible for IV-tPA. In this study, outcomes from groups of patients treated with additional IA thrombolytic therapy with the use or omission of IV-tPA administration were compared.
MATERIALS AND METHODS: IA thrombolytic therapy (thrombolytic agents combined with mechanical intervention) was attempted in those patients who were not eligible for IV-tPA and who showed continuous major vessel occlusion after IV-tPA. Sixty-three patients were divided into 2 groups: a tPA group (n = 29, IA thrombolysis after IV-tPA) and a non-tPA group (n = 34, IA thrombolysis without IV-tPA). These groups were subdivided according to match or mismatch DWI/PWI after MR imaging. Treatment results were compared by recanalization rate, clinical outcome, mortality, and ICH rate.
RESULTS: The recanalization rate was 79.3% in the tPA group and 55.9% in the non-tPA group (χ2 test, P < .05). Subgroup analysis between DWI/PWI mismatch in the tPA group and DWI/PWI mismatch in the non-tPA group also showed no statistical difference in recanalization rate, favorable clinical outcome, and mortality (χ2 test, P > .05), but the significant ICH rate was high in the tPA group (χ2 test, P < .05).
CONCLUSIONS: Additional IA thrombolytic treatment after full-dose IV-tPA administration might be an acceptable treatment option for patients with DWI/PWI mismatch.
Abbreviations
- Angio
- angiography
- D/P
- diffusion/perfusion
- DWI
- diffusion-weighted imaging
- EVD
- extra-ventricular drainage
- GCS
- Glasgow Coma Scale
- GP IIb/IIa
- platelet glycoprotein receptor IIb/IIa
- IA
- intra-arterial
- ICA
- internal carotid artery
- ICH
- intracerebral hemorrhage
- IICP
- increased intracranial pressure
- IV
- intravenous
- Lt.
- left
- MCA
- middle cerebral artery
- MRI
- MR imaging
- mRS
- modified Rankin Scale
- NIHSS
- National Institutes of Health Stroke Scale
- NINDS
- National Institute of Neurological Disorders and Stroke
- PWI
- perfusion-weighted imaging
- Rt.
- right
- Sx.
- symptom
- TIMI
- Thrombolysis in Myocardial Infarction
- tPA
- tissue plasminogen activator
- Tx.
- treatment
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