Mechanical thrombectomy following intravenous thrombolysis in the treatment of acute stroke.
BACKGROUND
The efficacy of intravenous thrombolytics in acute stroke is limited by low rates of recanalization of occluded arteries. Treatment with intravenous thrombolytics followed by mechanical thrombectomy is a novel approach that may increase recanalization rates without compromising time to initiation of treatment.


OBJECTIVE
To report our experience with 2 patients who received this combination therapy and outline plans for a prospective pilot study.


METHODS
Case studies at a university hospital.


METHODS
Patients treated with intravenous thrombolytics within 3 hours of symptom onset subsequently underwent computed tomographic angiography. If an occlusion of a proximal cerebral vessel was shown by a computed tomographic angiogram, mechanical thrombectomy was performed. Patients were observed for 1 month after treatment.


METHODS
National Institutes of Health Stroke Scale (NIHSS) score.


RESULTS
The computed tomographic angiography of 2 patients showed complete occlusion of the M1 branch of the middle cerebral artery following administration of intravenous thrombolytics. The NIHSS scores were 21 and 13. In both cases, blood flow through the occluded artery was restored with mechanical thrombectomy and dramatic neurologic improvement occurred. There were no complications. The NIHSS scores were 0 and 2 at 1-month follow-up.


CONCLUSIONS
Treatment with intravenous thrombolytics followed by mechanical thrombectomy may improve outcomes in acute stroke patients and a pilot safety trial is warranted.
Lansberg
Maarten G
MG
Department of Neurology, Stanford University Medical Center, Stanford, Calif 94305, USA.
Fields
Jeremy D
JD
Albers
Gregory W
GW
Jayaraman
Mahesh V
MV
Do
Huy M
HM
Marks
Michael P
MP
D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D010865:Pilot Projects; D020521:Stroke / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D017131:Thrombectomy; D013917:Thrombin / Q000627:therapeutic use*; D015912:Thrombolytic Therapy
D013917:Thrombin