Aggressive mechanical clot disruption: a safe adjunct to thrombolytic therapy in acute stroke?
OBJECTIVE
This study evaluated the safety and efficacy of aggressive mechanical clot disruption (AMCD) in acute stroke patients with persisting middle cerebral artery (MCA) or internal carotid artery (ICA) occlusion after thrombolytic therapy.


METHODS
Retrospective case series were used from a prospectively collected stroke database on consecutive acute ischemic stroke patients treated with intra-arterial (IA) thrombolytics and mechanical clot disruption during a 5-year interval. Thrombolytic dosage, endovascular techniques, immediate and final recanalization rates, symptomatic hemorrhage, mortality, and outcome were determined.


RESULTS
Thirty-two patients received AMCD. Median baseline National Institutes of Health Stroke Scale (NIHSS) score was 18, and median time to initiation of IA treatment was 261 minutes from symptom onset. ICA occlusion was noted in 16 patients and MCA occlusion in 16 patients: 22 received combined IV/IA thrombolytics, 3 received IV thrombolytics, 6 received IA thrombolytics, and 1 patient received no thrombolytics before AMCD. No immediate periprocedural complications were noted. Immediate recanalization was achieved in 38% (50% MCA, 25% ICA) and final recanalization in 75% (88% MCA, 63% ICA) of patients. Favorable outcome occurred in 19 (59%) patients, symptomatic cerebral hemorrhage in 3 (9.4%) patients, and mortality in 4 (12.5%) patients.


CONCLUSIONS
AMCD can be performed safely with comparable intracerebral hemorrhage and mortality rates to other IA therapies even after use of intravenous thrombolytics in selected patients. Early deployment of this technique leads to immediate recanalization in one third of patients. AMCD may potentially shorten the time to flow restoration and improve overall recanalization rates achieved with IA therapy.
Noser
Elizabeth A
EA
Department of Neurology, University of Texas-Houston Medical School, USA.
Shaltoni
Hashem M
HM
Hall
Christiana E
CE
Alexandrov
Andrei V
AV
Garami
Zsolt
Z
Cacayorin
Edwin D
ED
Song
Joon K
JK
Grotta
James C
JC
Campbell
Morgan S
MS
D000328:Adult; D000368:Aged; D002343:Carotid Artery, Internal / Q000473:pathology*; D016893:Carotid Stenosis / Q000628:therapy*; D002404:Catheterization / Q000295:instrumentation / Q000379:methods*; D019992:Databases as Topic; D005260:Female; D006470:Hemorrhage / Q000473:pathology; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000628:therapy*; D008875:Middle Aged; D010477:Perfusion; D012189:Retrospective Studies; D020521:Stroke / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000378:metabolism; D016896:Treatment Outcome
D010959:Tissue Plasminogen Activator